Sustainable food system transformation is inseparable from planetary health, the interdependent wellbeing of human populations and the ecological systems that sustain them. Agroecology and regenerative agriculture are frequently portrayed as competing paradigms for sustainable food system transformation. This commentary challenges this framing as both analytically unwarranted and practically counterproductive. Grounded in Ethiopia’s smallholder agricultural context and informed by recent empirical evidence, we argue that these two approaches are complementary and mutually reinforcing. Agroecology emerged from an equity-centered, participatory, and politically engaged framework for transforming food systems, while regenerative agriculture contributes farm-level ecological restoration tools and measurable biophysical outcomes related to planetary health. Neither is sufficient alone: regenerative practices without agroecology’s social architecture risk reinforcing existing inequities; agroecology without a systematic effort to ensure a widespread increase in production for food security and a net positive regeneration of environmental health cannot fully deliver its transformative potential, particularly in contexts where productivity, livelihoods, and ecosystem restoration must be achieved Ethiopia’s concurrent validation of a National Agroecology Strategy (2026–2040) and advancement of a National Regenerative Agriculture Strategy (2026–2036) reflects a growing national recognition that these paradigms are essential partners, not rivals. An integrated framework embedding regenerative practices within agroecological principles offers the most scientifically grounded and contextually appropriate pathway for Ethiopia’s resilient, equitable, and productive agricultural transformation. Reframed in these terms, agroecology–regenerative integration is not simply a technical or sectoral fix but a direct contribution to planetary health, safeguarding the ecological systems, food security, and social equity on which human wellbeing ultimately depends.
Our current moment is marked by profound institutional, ecological, and social upheaval. The unparalleled amassing of wealth by an infinitesimal percentage of the world’s population; populist movements on the left and right born of broken social contracts; escalating global conflicts and ecological collapse amidst breakneck technological advance—these are all emblematic of the uncharted ruptures that humans, our living kin, and our planetary system are currently weathering. The following viewpoint piece endeavors to shed light on the challenges, complexities, and opportunities of this polycrisis through the lens of academia. By highlighting the inherent contradiction that modern academia has unwittingly created through its narrow “apprenticeship” training structure, this paper first illustrates how one of the most highly skilled workforces in the world is nonetheless particularly ill-positioned to navigate the present moment holistically. The manuscript next argues that to address this gap, leaders of academia must expand their understanding of well-being, productivity, and expertise to include the fruits of their faculty members’ creative wellspring—a term that captures the humanistic, generative capabilities including vulnerability, reflection, courage, and connection that undergird value-based decision making, professional perseverance, and sustained collaboration with others. To move these ideas from theory to practice, the manuscript next emphasizes how the nurturance of a coaching ethos can support faculty in reenchanting their academic careers. The implications of an increasingly holistic, creative notion of expertise for promoting social and planetary flourishing are also considered.
This study presents the relationship between climate variables and malaria outbreaks and forecasts the future malaria incidence in Arba Minch Town and its surrounding areas. High-resolution gridded climate data (~4 km × 4 km) covering the period 1981 to 2020 was obtained from the Ethiopian Meteorological Institute. Additionally, Coupled Model Intercomparison Project Phase 6 (CMIP6) model simulations under two shared socioeconomic pathways (SSP2-4.5 and SSP5-8.5) were used to analyze future climate patterns. Malaria case data were obtained from local health centers located in Arba Minch town and surrounding woredas. Malaria projections were simulated using the Seasonal Autoregressive Integrated Moving Average (SARIMAX) model. Climate projections indicate a significant rise in mean temperature by the end of 21st century, increasing by 2.9 °C under SSP2-4.5 and 3.48 °C under SSP5-8.5. Average monthly rainfall during the baseline period (70.53 mm) is expected to increase to 94.18 mm and 86.09 mm under the SSP2-4.5 and SSP5-8.5 scenarios, respectively. Malaria case distribution during the baseline period (2005–2017) ranged from 79 to 552 cases per month, while future projections suggest that cases will increase by approximately 600 in the near-term and up to more than 1000 cases by the end of the century. The SARIMAX model effectively captured seasonal variations and short-term fluctuations demonstrating a strong forecasting performance. The model generally indicated that wetter conditions and moderate temperatures will favor mosquito breeding and intensify malaria transmission.
Environmental change, accelerated by increasing global temperatures, has become a defining economic, ecological, and public health issue of the twenty-first century. This study presents an economic evaluation of early mortality associated with air pollution, a major factor underlying worldwide patterns of illness and premature mortality, through which climate change affects global population health. Using secondary global mortality estimates and an economic valuation framework, both tangible costs (e.g., economic output and income losses) and quality-of-life loss (e.g., welfare loss associated with premature mortality) are estimated. The paper contributes to planetary health scholarship by integrating established economic valuation approaches with harm-reduction and systems-based perspectives to reinterpret air pollution as an interconnected environmental, economic, and societal challenge rather than solely a public health issue. Air pollution is associated with reduced life expectancy and approximately 3 million premature deaths annually worldwide. The estimated annual tangible economic burden is approximately US$940.9 billion (range: US$550.5 billion–US$1.65 trillion), while intangible costs are estimated at US$37.8 trillion annually (range: US$13.3 trillion–US$48.8 trillion). The findings suggest that air pollution should be understood not merely as a health-related challenge but also as a broader planetary health challenge with implications for environmental sustainability, economic resilience, and long-term societal well-being. Targeted air quality interventions and pollution reduction strategies may therefore generate substantial public health and societal co-benefits worldwide.
Climate change, soil degradation, and the disruption of global nutrient cycles are placing unprecedented pressure on agricultural systems and global food security. These challenges are increasingly recognized as central concerns for planetary health, as agriculture simultaneously depends upon and alters critical Earth system processes. Microbe-based agricultural inputs (including biofertilizers, biostimulants, and biocontrol agents) have been widely promoted as climate-smart solutions capable of enhancing productivity, resilience, and environmental sustainability. However, despite rapid scientific and commercial advances, their performance in the field remains highly variable and strongly context-dependent. This review critically examines the evidence base underpinning climate-smart microbial solutions, with a particular focus on their capacity to confer climate resilience across diverse crops, soils, and climatic conditions. We synthesize current knowledge on the functional roles of beneficial microorganisms, including extremophilic and stress-adapted taxa, while highlighting key biological, technological, ecological, and socio-economic constraints that limit predictability and scalability. Special attention is given to evidence gaps related to long-term field performance, ecosystem-level impacts, and the trade-offs associated with widespread microbial deployment. We further assess recent innovations such as synthetic microbial consortia, microbiome engineering, advanced formulations, and data-driven decision tools. Then we highlight how these new technologies may address context dependency but still need validation under real-world conditions. Finally, we discuss policy, regulatory, and capacity-building considerations required to responsibly integrate microbial solutions into climate-smart agriculture frameworks. Overall, this review argues that microbial inoculants should be viewed not as universal inputs but as context-specific tools whose successful deployment depends on robust evidence, ecological sensitivity, and system-level integration. Advancing microbial solutions for agriculture will therefore require aligning technological innovation with broader planetary health objectives, ensuring that efforts to enhance agricultural productivity also support long-term ecosystem stability and resilience.
Climate change and environmental degradation are increasingly recognized as major drivers of human mobility, operating through both sudden-onset disasters and slow-onset processes such as sea-level rise, desertification and resource scarcity. Although estimates vary widely, projections suggest that millions of people may become displaced by 2050 because of climate change, predominantly within their own countries but also across international borders. This article examines the emerging phenomenon of “environmental migration” against the backdrop of international refugee law and broader human rights frameworks. It first maps the diverse environmental scenarios that trigger displacement before analyzing the existing international legal landscape. Particular attention is paid to the contested terminology surrounding “climate refugees”, “environmental migrants” and “environmentally displaced persons” and to the protection gaps that arise from current categorizations. This article argues that, while existing norms on human rights, disaster risk reduction and internal displacement offer partial safeguards, they do not provide coherent legal status or systematic protection for people displaced across borders by climate-related harms. It concludes that climate-related displacement should be addressed through a combination of evolving human rights-based climate litigation, enhanced use of existing instruments and the progressive elaboration of specific normative frameworks.
Tikanga Māori, the indigenous system of values, principles, and practices in Aotearoa New Zealand, offers a relational, ethics-based framework for responding to contemporary global challenges such as geopolitical instability, environmental degradation, and digital disruption. Dominant Western approaches, often grounded in individualism and resource extraction, are increasingly limited in addressing these issues. Drawing on Aotearoa New Zealand as a case study, tikanga is presented as a living system centred on interconnectedness, responsibility, and collective wellbeing. Examples from law, health, research ethics, and sport demonstrate how these values shape both institutional practice and everyday behaviour. Rather than functioning as a cultural add-on, tikanga provides an alternative way of understanding relationships between people, communities, and the environment. The analysis highlights the relevance of tikanga-informed approaches for rethinking governance, leadership, and sustainability in an increasingly complex and interconnected world.
Contemporary Blue Planetary Health frameworks frequently approach marine degradation primarily as a technical management problem while insufficiently addressing the relational, ethical, and political–economic conditions driving ocean collapse. The framework proposes that dominant marine governance paradigms continue to reproduce anthropocentric and extractivist assumptions that reduce oceans to economic assets rather than recognizing them as living multispecies relational systems. In response, the study develops the Blue Stratified Relational Responsibility Framework (BSRRF), an interdisciplinary model integrating multispecies ethics, marine psychophysiology, environmental humanities, political ecology, Indigenous relational ontologies, and ocean governance. The framework advances three central claims: marine sustainability requires relational rather than purely instrumental governance; humans possess asymmetrical ecological responsibility due to their technological and institutional power; and meaningful Blue Planetary Health transformation requires simultaneous shifts in moral imagination, affective perception, governance systems, and political economy. The study further critiques dominant Blue Economy paradigms for reproducing extractivist and colonial dynamics under narratives of sustainability and innovation. Ultimately, the framework argues that although the ocean crisis manifests ecologically, its underlying drivers are simultaneously epistemological, political, economic, and civilizational. Consequently, advancing Blue Planetary Health requires integrated transformations in education, governance, public policy, and multispecies ethical responsibility.
This article advances a transdisciplinary framework for planetary health education grounded in multispecies responsibility and Indigenous relational ontologies. Addressing the limitations of anthropocentric environmental paradigms, the paper proposes an expanded Stratified Relational Responsibility Model integrating ethical, ecological, and neurobiological dimensions of human–more-than-human relations. The framework bridges insights from environmental ethics, anthropology, and affective neuroscience to examine how relational awareness, emotional regulation, and embodied cognition shape pro-environmental behavior. Four pedagogical pillars are introduced to support behavioral transformation, emphasizing relational perception, affective attunement, ethical reflexivity, and collective responsibility. The article further discusses implementation challenges within Western educational contexts and highlights the need for culturally responsive adaptation. By situating human agency within multispecies networks, the model contributes to ongoing debates in planetary health and sustainability education, offering a theoretically robust and practically oriented approach to fostering ecological responsibility.
While spirituality and contemplative practices are increasingly invoked in response to environmental crisis, the specific mechanisms by which they may mediate professional ethical action remain underdeveloped. This is particularly evident regarding nuclear harm, an existential planetary threat often siloed from health scholarship. This paper investigates the mediating mechanism of contemplative formation as the analytical link between spiritual ethics and planetary health. By centering this link, we demonstrate how professional nursing identity can be restructured to address existential threats like nuclear harm, which are currently under-integrated in health scholarship. We employed a convergent, integrative design combining a scoping review of the literature published in 2015–2025 with a contemplative autoethnography. The scoping review (n = 39) maps the scholarly evidence of spiritual–ecological constructs, while the autoethnography provides a situated, analytical account of the first author’s professional and spiritual formation. Integration was achieved through a four-step thematic synthesis that explicitly identifies where first-person lived experience and third-person scholarly evidence converge to illuminate the process of ethical integration. Four convergent themes describe the pathways linking contemplative practice to planetary health: (1) embodied practice (somatic resilience); (2) narrative meaning-making (transforming grief into purpose); (3) interconnected ethics (reframing remote harms as proximate responsibilities); and (4) reflective integration (the reflexive weaving of clinical and spiritual identities). The findings reveal that while contemplative traditions offer robust resources for systems thinking and equity, nuclear harm and nursing perspectives remain significantly under-integrated in the current planetary health literature. Contemplative formation functions as the mediating mechanism that turns planetary threats into sustained professional advocacy. The Interbeing Planetary Health Framework provides a pragmatic guide for nursing ethics under existential risks.
Consumer electronics are important for global energy use, material extraction, and toxic exposures. Within consumer behavior, End-of-Current-Use (EoCU) decisions (e.g., to resell, donate, recycle, or throw away) particularly are a planetary health concern, not just a waste management problem. The goal of this work is to inform interventions that nudge users toward more sustainable and data-secure choices. We surveyed 4000 U.S. users on their attitudes, knowledge, and planned EoCU choices, and constructed a Random Forest model to simulate planned behavior as a function of reported knowledge and attitudes. The key result is identification of behavioral “tipping points”, i.e., incremental shifts in knowledge or attitude that produce large changes in sustainable behavior. For example, moving the level of agreement relating to “reselling is worthwhile” from “Neutral” to “Agree” increases the probability of resale by 26%, with stronger agreement yielding minimal further gains, suggesting relatively small changes in perception may thus produce large behavioral changes. The model also identifies trade-offs, with increases in agreeing that resale is worthwhile leading to to decreases in giving away (−14%) and recycling (−10%). Economic considerations drive reselling decisions, while environmental concerns drive recycling. Identifying these critical thresholds enables efficient intervention design, as modest attitude changes at transition points may prove more effective than maximizing positive attitudes. These finding challenge assumptions of linearity of behavioral responses, informing circular economy and other policies. They also relate to managing planetary health issues raised by EoCU electronics, such as human and ecological well being, digital equity, and environmental justice. The framework is broadly applicable to identifying behavioral tipping points in other domains, e.g., healthcare, energy efficiency, and data security.
Environmental noise has emerged as a pervasive yet frequently underestimated environmental stressor with consequences for biodiversity, public health, and societal well-being. Although a substantial body of epidemiological research has linked chronic transportation-related noise exposure with cardiovascular disease, sleep disturbance, psychological distress, impaired cognitive performance, and premature mortality, comparatively few studies have estimated its broader economic burden within a planetary health framework. This study presents an exploratory order-of-magnitude economic valuation based on a large-cohort epidemiological risk-transfer scenario. A hazard-ratio-based framework was applied to estimate noise-attributable mortality among populations subjected to road traffic environmental noise levels above 60 dB. Both tangible costs, representing forgone economic productivity, and intangible costs, representing societal welfare losses using the Value of a Statistical Life framework, were estimated. Under baseline assumptions, chronic transportation-related environmental noise was associated with approximately 27,692 annual attributable deaths—when applying a hazard-based ratio—estimated annual productivity losses of approximately US$7.28 billion and welfare losses valued at approximately US$353.91 billion under the Value of a Statistical Life framework. These findings suggest that chronic transportation-related environmental noise represents a potentially important, though often overlooked, environmental externality with substantial health and economic implications. The proposed framework provides an initial basis for future research evaluating the wellbeing, societal, and economic magnitude of environmental noise within a planetary health context.
Amid escalating ecological degradation, social fragmentation, and rising mental health challenges—especially in rural and agricultural communities—there is an urgent need to reimagine systems that support both planetary and human flourishing. This viewpoint examines an emerging paradigm in agriculture that emphasizes the role of farmers’ inner development in fostering practices that enhance ecological health, community well-being, and a resilient food system. A key goal is to draw more academic attention to growing community calls for more holistic, relational, and spiritually grounded approaches to food systems as an important focus for ongoing research. Drawing on diverse case studies from Japan, India, and Europe, we examine how small-scale and natural farming initiatives are integrating inner development, universal human values, and ecological consciousness. These case studies were developed and/or refined through a program led by the Conscious Food Systems Alliance (CoFSA), an initiative of the United Nations Development Programme (UNDP) that seeks to integrate inner transformation with sustainable food systems change. The initiatives are intended as illustrative examples of how agriculture can transcend its conventional, anthropocentric role as a food production system to become a site for cultivating deeper self-awareness, spiritual connection, and regenerative relationships with nature. Participants in these cases reported significant shifts in mindset—from materialistic and extractive worldviews to more relational and value-driven orientations rooted in care, cooperation, and sustainability. Core practices such as mindfulness, experiential learning, and spiritual ecology helped reframe farming as a holistic process that nurtures both land and life. These exploratory case studies suggest that when farmers are supported in aligning with inner values and natural systems, they become empowered as agents of systemic change. By linking personal growth with planetary stewardship, these models offer pathways toward more integrated, life-affirming approaches to agriculture and future academic research.
Sustainable diet transitions are required to protect human and planetary health, and consumers are important food systems actors who can foster positive changes. However, little is known about how consumers perceive the concept of sustainable diets. This study explored perceptions of sustainable diets across five high- and middle-income countries: Japan, Indonesia, Italy, Canada, and Mexico. Semi-structured interviews were conducted with 184 young adults (30–45 per country), and transcripts were analyzed using values coding to understand the values, attitudes, and beliefs that shape behaviours related to sustainable diets. Results revealed that defining “sustainable eating” was challenging for participants across all countries. While participants’ values regarding sustainable diets were often context-specific with marked differences across countries, common themes across countries included concern about food waste and packaging and the belief that sustainability should be the responsibility of all actors across the food system, not just the individual. These findings indicate that food policy should address both individual and systemic dimensions of food sustainability, specifically prioritizing strategies for waste and packaging infrastructure. Furthermore, public health strategies must be values-oriented and culturally tailored to ensure they resonate with local consumer priorities.
Housing stock is observed to be associated with high carbon emissions, high fuel poverty and low comfort levels in the UK. Retrofitting the housing stock is one of the best solutions to address these problems. This paper directly corresponds with human and planetary health in terms of climate change, human health and mental health by addressing the challenges of housing retrofit at scale. Retrofitting houses can also contribute to social equity, reduced use of planetary resources and better financial and physical comfort. Despite the availability of the right technology, government grants and the potential to acquire supply chain and skilled labour, the progress of retrofit is extremely poor. Importantly, the UK is off track to achieve net zero by 2050, and the housing stock contributes 18.72% of the total emissions. The problem is further exacerbated by the 30.4 million units of housing stock. Robust strategies are required to retrofit the housing stock at scale. The study uses a qualitative modelling method under the diffusion of innovations theory to formulate a retrofit-at-scale strategy for the UK. Findings recommend focusing on skill development, show homes, research and innovation, supply chain development, business models, government grants and regulatory tools in a trajectory from 2025 to 2050. The proposed strategy is aligned with the segments of the diffusion of innovation theory. Although the analysis was performed with reference to the UK, the findings are transferable, considering the broader and urgent concerns related to human and planetary health.
Early pandemic disruptions exposed critical vulnerabilities in special education systems, particularly in referral and evaluation processes governed by the Individuals with Disabilities Education Act (IDEA). This convergent mixed-methods study examined how 86 educational diagnosticians across Louisiana experienced and responded to these disruptions. Quantitative results showed a 38% decline in referrals during school closures followed by a 62% rebound, prolonged evaluation timelines, and notable increases in emotional/behavioral disabilities, other health impairments, and specific learning disabilities. Qualitative findings elaborated on these patterns, revealing challenges related to assessment validity, communication barriers, workload strain, and professional learning needs. Interpreted through systems theory and planetary health frameworks, the findings position special education evaluation systems as critical social infrastructure that links educational continuity, equity, and population well-being. Strengthening diagnostic capacity, digital infrastructure, and crisis-responsive practices is therefore essential not only for IDEA compliance, but for advancing planetary health goals related to resilience, justice, and sustainable human development.
Livestock contributes to economic stability and food security by providing income, employment, and nutrient-dense animal-source foods, particularly in low- and middle-income regions. However, the sector is also a major source of anthropogenic greenhouse gas emissions, primarily methane, nitrous oxide, and carbon dioxide, raising growing environmental and public health concerns. This review synthesizes current evidence on strategies to mitigate greenhouse gas emissions from livestock systems while safeguarding productivity, food security, and human health. Emphasis is placed on the need to balance supply-side mitigation measures with demand-side interventions to avoid unintended nutritional and socio-economic consequences. Key supply-side approaches discussed include genetic improvement, optimized feeding strategies, manure and land resource management, and system-level efficiency gains. Demand-side strategies include food loss and waste reduction, shifts toward sustainable dietary patterns, and the development of alternative protein sources. Central to this review is the integration of these approaches within a planetary health framework, highlighting the interconnectedness of environmental sustainability, human and animal health, and socio-economic resilience. The review underscores that mitigation policies should be context-specific, equity-focused, and health-centered to ensure that climate goals are met without compromising access to affordable, nutritious foods. Collectively, the evidence indicates that coordinated policy action across production, consumption, and health systems is essential for achieving sustainable animal-source food production with reduced climate impact.
Plastic pollution constitutes a critical planetary health challenge, undermining the integrity of Earth systems while generating cascading harms to human health, livelihoods, and social equity particularly in low- and middle-income countries. Conventional top-down regulatory and technological responses have proven insufficient to address the complexity of plastic pollution, often excluding those most affected from decision-making and solution design. This paper examines how democratizing plastic governance through grassroots leadership can advance planetary health by simultaneously protecting ecosystems, improving human well-being, and strengthening socio-ecological resilience. Drawing on empirical evidence from the #RestorationX10000 initiative led by Community Action Against Plastic Waste (CAPws), this paper documents implementation processes and outcomes achieved between 2021 and 2025 across 71 impacted communities in 21 countries spanning Africa, Asia-Pacific, and Latin America. The initiative was designed to empower 10,000 youths and women as community leaders, practitioners, and advocates by equipping them with leadership, technical, and policy engagement skills to drive systemic change in plastic governance and circular economy practice. Using a transdisciplinary, community-based action research approach aligned with planetary health principles, the initiative integrates capacity building, citizen science, circular economy interventions (collection, sorting, repair, reuse, repurposing, and recycling), and policy advocacy. Quantitative and qualitative evidence demonstrates that grassroots-led interventions can simultaneously reduce plastic leakage, create decent green livelihoods, and strengthen environmental governance. We argue that inclusive, community-centered plastic governance is not only an environmental intervention but a planetary health strategy, offering policy-relevant insights for national plastic action plans, extended producer responsibility frameworks, and global negotiations toward a legally binding instrument on plastic pollution.
Climate change has emerged as a defining global crisis, with the frequency and intensity of climate-induced disasters rising sharply and imposing disproportionate costs on developing economies and small island states. This article examines the role of climate-resilient infrastructure as a central pillar of climate-smart growth, integrating mitigation, adaptation, and long-term development objectives. It situates climate-resilient infrastructure within a planetary health setting, emphasizing the interdependence between human well-being, ecological systems, and infrastructure resilience. Climate-resilient infrastructure, not merely seen as an engineering solution but as a public good that generates significant positive externalities, reduces systemic macroeconomic risk and delivers welfare gains that exceed private financial returns. It discusses the cross-country heterogeneities in resilience outcomes, driven by differences in geographic exposure, economic capacity, institutional quality, and political economy constraints. Building on this, the study advances a welfare-based approach to infrastructure prioritization that incorporates service disruptions, distributional impacts, and fiscal risk, rather than asset values alone. It further outlines policy and financing strategies to bridge the gap between social and private returns, including public investment, concessional finance, blended instruments, and nature-based solutions. By embedding infrastructure within a planetary health lens, the paper argues that resilient systems are critical not only for safeguarding lives and livelihoods, but also for sustaining ecological stability, reducing health risks, and enabling inclusive, sustainable, and climate-smart economic growth.
Background: Heat exposure is a leading climate-related health threat, yet whether the heat–disease burden relationship is moderated by national adaptive capacity remains poorly quantified at the global level. We examined associations between heat exposure and cause-specific disability-adjusted life year (DALY) burden across climate vulnerability strata and projected future burden to 2050 under IPCC AR6 warming scenarios. Methods: We constructed a country–year panel spanning 187 countries and 34 years (1990–2023) by merging ERA5 reanalysis temperature data; GBD 2023 DALY rates for cardiovascular diseases (CVD), chronic kidney disease (CKD), and chronic respiratory diseases (CRD); ND-GAIN adaptive-capacity scores; and WHO GHO health system indicators. Countries were stratified into adaptive-capacity tertiles (Low: n = 63; Medium: n = 62; High: n = 62). We used two-way fixed-effects panel regression with country-clustered standard errors, a formal Chow test of slope equality, lagged exposure models, and a benefit-of-adaptation counterfactual. Future DALY burden was projected to 2030, 2045, and 2050 using country-specific ERA5 warming trends scaled to IPCC AR6 SSP scenario multipliers. Findings: The heat–CVD dose–response was 26 times larger in Low versus High adaptive-capacity countries (β = −346.2 vs. −13.1 DALY years per 100,000 per °C). The Chow test confirmed statistically significant slope heterogeneity across tertiles for all three outcomes (CVD: F = 22.0, p < 0.0001; CKD: F = 14.9, p < 0.0001; CRD: F = 9.4, p < 0.0001). CKD burden rose 47·8% globally between 1990 and 2023, with the strongest within-country heat–CKD association in Medium adaptive-capacity countries (β = −61.5, p < 0.0001). These findings were robust to lagged exposure specifications. Under SSP5-8.5 by 2050, Low adaptive-capacity countries face a projected CVD DALY rate change 23 times larger than High adaptive-capacity countries (−16.2% vs. −0.7%). Upgrading Low adaptive-capacity countries to High tertile standards would avert 15.6% of projected CVD DALY burden under SSP5-8.5 by 2050. Conclusions: Adaptive capacity substantially moderates the health consequences of heat exposure. The quantified benefit of adaptation investment—expressed as averted DALY burden—provides a direct metric for health-system strengthening and climate adaptation financing, particularly in low-income settings facing the steepest projected burden increases. These results position adaptive capacity as a critical social determinant of planetary health, linking Earth-system boundary transgression to inequitably distributed human disease burden across the global community.
