Safeguarding Human Health in the Anthropocene Epoch: Report of the Rockefeller Foundation–Lancet Commission on Planetary Health

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 civilisation has flourished but now risks substantial health effects from the degradation of nature's life support systems in the future. Health effects from changes to the environment including climatic change, ocean acidification, land degradation, water scarcity, overexploitation of fisheries, and biodiversity loss pose serious challenges to the global health gains of the past several decades and are likely to become increasingly dominant during the second half of this century and beyond. These striking trends are driven by highly inequitable, inefficient, and unsustainable patterns of resource consumption and technological development, together with population growth. We identify three categories of challenges that have to be addressed to maintain and enhance human health in the face of increasingly harmful environmental trends. Firstly, conceptual and empathy failures (imagination challenges), such as an over-reliance on gross domestic product as a measure of human progress, the failure to account for future health and environmental harms over present day gains, and the disproportionate effect of those harms on the poor and those in developing nations. Secondly, knowledge failures (research and information challenges), such as failure to address social and environmental drivers of ill health, a historical scarcity of transdisciplinary research and funding, together with an unwillingness or inability to deal with uncertainty within decision making frameworks. Thirdly, implementation failures (governance challenges), such as how governments and institutions delay recognition and responses to threats, especially when faced with uncertainties, pooled common resources, and time lags between action and effect. Although better evidence is needed to underpin appropriate policies than is available at present, this should not be used as an excuse for inaction. Substantial potential exists to link action to reduce environmental damage with improved health outcomes for nations at all levels of economic development. This Commission identifies opportunities for action by six key constituencies: health professionals, research funders and the academic community, the UN and Bretton Woods bodies, governments, investors and corporate reporting bodies, and civil society organisations. Depreciation of natural capital and nature's subsidy should be accounted for so that economy and nature are not falsely separated. Policies should balance social progress, environmental sustainability, and the economy. To support a world population of 9–10 billion people or more, resilient food and agricultural systems are needed to address both undernutrition and overnutrition, reduce waste, diversify diets, and minimise environmental damage. Meeting the need for modern family planning can improve health in the short term—eg, from reduced maternal mortality and reduced pressures on the environment and on infrastructure. Planetary health offers an unprecedented opportunity for advocacy of global and national reforms of taxes and subsidies for many sectors of the economy, including energy, agriculture, water, fisheries, and health. Regional trade treaties should act to further incorporate the protection of health in the near and long term. Several essential steps need to be taken to transform the economy to support planetary health. These steps include a reduction of waste through the creation of products that are more durable and require less energy and materials to manufacture than those often produced at present; the incentivisation of recycling, reuse, and repair; and the substitution of hazardous materials with safer alternatives. Key messages1The concept of planetary health is based on the understanding that human health and human civilisation depend on flourishing natural systems and the wise stewardship of those natural systems. However, natural systems are being degraded to an extent unprecedented in human history.2Environmental threats to human health and human civilisation will be characterised by surprise and uncertainty. Our societies face clear and potent dangers that require urgent and transformative actions to protect present and future generations.3The present systems of governance and organisation of human knowledge are inadequate to address the threats to planetary health. We call for improved governance to aid the integration of social, economic, and environmental policies and for the creation, synthesis, and application of interdisciplinary knowledge to strengthen planetary health.4Solutions lie within reach and should be based on the redefinition of prosperity to focus on the enhancement of quality of life and delivery of improved health for all, together with respect for the integrity of natural systems. This endeavour will necessitate that societies address the drivers of environmental change by promoting sustainable and equitable patterns of consumption, reducing population growth, and harnessing the power of technology for change. 1The concept of planetary health is based on the understanding that human health and human civilisation depend on flourishing natural systems and the wise stewardship of those natural systems. However, natural systems are being degraded to an extent unprecedented in human history.2Environmental threats to human health and human civilisation will be characterised by surprise and uncertainty. Our societies face clear and potent dangers that require urgent and transformative actions to protect present and future generations.3The present systems of governance and organisation of human knowledge are inadequate to address the threats to planetary health. We call for improved governance to aid the integration of social, economic, and environmental policies and for the creation, synthesis, and application of interdisciplinary knowledge to strengthen planetary health.4Solutions lie within reach and should be based on the redefinition of prosperity to focus on the enhancement of quality of life and delivery of improved health for all, together with respect for the integrity of natural systems. This endeavour will necessitate that societies address the drivers of environmental change by promoting sustainable and equitable patterns of consumption, reducing population growth, and harnessing the power of technology for change. Despite present limitations, the Sustainable Development Goals provide a great opportunity to integrate health and sustainability through the judicious selection of relevant indicators relevant to human wellbeing, the enabling infrastructure for development, and the supporting natural systems, together with the need for strong governance. The landscape, ecosystems, and the biodiversity they contain can be managed to protect natural systems, and indirectly, reduce human disease risk. Intact and restored ecosystems can contribute to resilience (see panel 1 for glossary of terms used in this report), for example, through improved coastal protection (eg, through wave attenuation) and the ability of floodplains and greening of river catchments to protect from river flooding events by diverting and holding excess water.Panel 1GlossaryHolocene1International Commission on StratigraphyInternational stratigraphic chart.http://www.stratigraphy.org/ICSchart/ChronostratChart2013-01.pdfDate: 2013Google ScholarA geological epoch that began about 11 700 years ago and encompasses most of the time period during which humanity has grown and developed, including all its written history and development of major civilisations.Anthropocene2Crutzen PJ Geology of mankind.Nature. 2002; 415: 23Crossref PubMed Scopus (1931) Google ScholarThe proposed name for a new geological epoch demarcated as the time when human activities began to have a substantial global effect on the Earth's systems. The Anthropocene has to be yet formally recognised as a new geological epoch and several dates have been put forward to mark its beginning.Ecosystem3Millennium Ecosystem AssessmentEcosystems and human wellbeing: health synthesis.in: Corvalan C Hales S McMichael AJ Island Press, Washington DC2005Google ScholarA dynamic complex of plant, animal, and microorganism communities and the non-living environment acting as a functional unit.Ecosystem services4UKNEAThe UK National Ecosystem Assessment: technical report. United Nations Environment Programme's World Conservation Monitoring Centre, Cambridge, UK2011Google ScholarThe benefits provided by ecosystems that contribute to making human life both possible and worth living. Examples of ecosystem services include products such as food and clean water, regulation of floods, soil erosion, and disease outbreaks, and non-material benefits such as recreational and spiritual benefits in natural areas. The term services is usually used to encompass the tangible and intangible benefits that human beings obtain from ecosystems, which are sometimes separated into goods and services.Biodiversity5Millennium Ecosystem AssessmentBiodiversity.in: Mace G Masundire H Baillie J Millennium ecosystem assessment: current state and trends: findings of the condition and trends working group ecosystems and human well-being. Island Press, Washington, DC2005Google ScholarAn abbreviation of biological diversity; biodiversity means the variability among living organisms from all sources, including inter alia, terrestrial, marine, and other aquatic ecosystems and the ecological complexes of which they are part. This variability includes diversity within species, between species, and of ecosystems.Wetland6RamsarConvention on wetlands of international importance especially as waterfowl habitat 1971. Iran, Feb 2, 1971. As amended by the protocol of Dec 3, 1982, and the amendments of May 28, 1987.http://portal.unesco.org/en/ev.php-URL_ID=15398&URL_DO=DO_TOPIC&URL_SECTION=201.htmlGoogle ScholarThe Ramsar Convention defines wetlands as “areas of marsh, fen, peatland or water, whether natural or artificial, permanent or temporary, with water that is static or flowing, fresh, brackish or salt, including areas of marine water the depth of which at low tide does not exceed six metres”.Representative Concentration Pathway (RCP)7IPCCClimate change 2013. The Physical Science Basis Working Group I contribution to the fifth assessment report of the Intergovernmental Panel on Climate Change. Cambridge University Press, Intergovernmental Panel on Climate Change, Cambridge, UK and New York, USA2013Google ScholarRCPs are trajectories of the concentrations of greenhouse gases in the atmosphere consistent with a range of possible future emissions. For the Fifth Assessment Report of Intergovernmental Panel on Climate Change, the scientific community has defined a set of four RCPs. They are identified by their approximate total radiative forcing (ie, warming effect) in the year 2100 relative to 1750. RCP 8·5 is a pathway with very high greenhouse gas emissions, but such emissions are in line with present trends.Social–ecological systems8Stockholm Resilience CentreResilience dictionary.http://www.stockholmresilience.org/21/research/what-is-resilience/resilience-dictionary.htmlDate: 2015Google ScholarNatural systems do not exist without people and social systems cannot exist totally in isolation from nature. These systems are truly interconnected and coevolve across spatial and temporal scales.REDD+9UN-REDD ProgrammeAbout REDD+.http://www.un-redd.org/aboutreddDate: 2015Google ScholarReducing Emissions from Deforestation and Forest Degradation (REDD) tries to assign a financial value to the carbon stored in trees to help developing countries invest in low-carbon paths to sustainable development. REDD+ includes an added focus on conservation, sustainable management of forests, and enhancement of forest carbon stocks.Externalities10Buchanan JM Stubblebine WC Externality.Economica. 1962; 29: 371-384Crossref Google ScholarA benefit or cost that affects an individual or group of people who did not choose to incur that benefit or cost.Circular economy11European CommissionTowards a circular economy: a zero waste programme for Europe.http://eur-lex.europa.eu/legal-content/EN/TXT/?uri=CELEX:52014DC0398Date: 2014Google ScholarA global economic model that decouples economic growth and development from the consumption of finite resources. Circular economy systems keep products in use for as long as possible, allow for the recycling of end products, and eliminate waste.State shift12Rocha JC Biggs R Peterson GD Regime shifts: what are they and why do they matter?.http://www.regimeshifts.org/datasets-resources/Date: 2014Google ScholarLarge, lasting changes in the structure and function of social–ecological systems, with substantial impacts on the ecosystem services provided by these systems.Resilience8Stockholm Resilience CentreResilience dictionary.http://www.stockholmresilience.org/21/research/what-is-resilience/resilience-dictionary.htmlDate: 2015Google Scholar, 13Rodin J The resilience dividend: being strong in a world where things go wrong. PublicAffairs, New York2014Google Scholar“the capacity of any entity—an individual, a community, an organization, or a natural system—to prepare for disruptions, to recover from shocks and stresses, and to adapt and grow from a disruptive experience.” Holocene1International Commission on StratigraphyInternational stratigraphic chart.http://www.stratigraphy.org/ICSchart/ChronostratChart2013-01.pdfDate: 2013Google Scholar A geological epoch that began about 11 700 years ago and encompasses most of the time period during which humanity has grown and developed, including all its written history and development of major civilisations. Anthropocene2Crutzen PJ Geology of mankind.Nature. 2002; 415: 23Crossref PubMed Scopus (1931) Google Scholar The proposed name for a new geological epoch demarcated as the time when human activities began to have a substantial global effect on the Earth's systems. The Anthropocene has to be yet formally recognised as a new geological epoch and several dates have been put forward to mark its beginning. Ecosystem3Millennium Ecosystem AssessmentEcosystems and human wellbeing: health synthesis.in: Corvalan C Hales S McMichael AJ Island Press, Washington DC2005Google Scholar A dynamic complex of plant, animal, and microorganism communities and the non-living environment acting as a functional unit. Ecosystem services4UKNEAThe UK National Ecosystem Assessment: technical report. United Nations Environment Programme's World Conservation Monitoring Centre, Cambridge, UK2011Google Scholar The benefits provided by ecosystems that contribute to making human life both possible and worth living. Examples of ecosystem services include products such as food and clean water, regulation of floods, soil erosion, and disease outbreaks, and non-material benefits such as recreational and spiritual benefits in natural areas. The term services is usually used to encompass the tangible and intangible benefits that human beings obtain from ecosystems, which are sometimes separated into goods and services. Biodiversity5Millennium Ecosystem AssessmentBiodiversity.in: Mace G Masundire H Baillie J Millennium ecosystem assessment: current state and trends: findings of the condition and trends working group ecosystems and human well-being. Island Press, Washington, DC2005Google Scholar An abbreviation of biological diversity; biodiversity means the variability among living organisms from all sources, including inter alia, terrestrial, marine, and other aquatic ecosystems and the ecological complexes of which they are part. This variability includes diversity within species, between species, and of ecosystems. Wetland6RamsarConvention on wetlands of international importance especially as waterfowl habitat 1971. Iran, Feb 2, 1971. As amended by the protocol of Dec 3, 1982, and the amendments of May 28, 1987.http://portal.unesco.org/en/ev.php-URL_ID=15398&URL_DO=DO_TOPIC&URL_SECTION=201.htmlGoogle Scholar The Ramsar Convention defines wetlands as “areas of marsh, fen, peatland or water, whether natural or artificial, permanent or temporary, with water that is static or flowing, fresh, brackish or salt, including areas of marine water the depth of which at low tide does not exceed six metres”. Representative Concentration Pathway (RCP)7IPCCClimate change 2013. The Physical Science Basis Working Group I contribution to the fifth assessment report of the Intergovernmental Panel on Climate Change. Cambridge University Press, Intergovernmental Panel on Climate Change, Cambridge, UK and New York, USA2013Google Scholar RCPs are trajectories of the concentrations of greenhouse gases in the atmosphere consistent with a range of possible future emissions. For the Fifth Assessment Report of Intergovernmental Panel on Climate Change, the scientific community has defined a set of four RCPs. They are identified by their approximate total radiative forcing (ie, warming effect) in the year 2100 relative to 1750. RCP 8·5 is a pathway with very high greenhouse gas emissions, but such emissions are in line with present trends. Social–ecological systems8Stockholm Resilience CentreResilience dictionary.http://www.stockholmresilience.org/21/research/what-is-resilience/resilience-dictionary.htmlDate: 2015Google Scholar Natural systems do not exist without people and social systems cannot exist totally in isolation from nature. These systems are truly interconnected and coevolve across spatial and temporal scales. REDD+9UN-REDD ProgrammeAbout REDD+.http://www.un-redd.org/aboutreddDate: 2015Google Scholar Reducing Emissions from Deforestation and Forest Degradation (REDD) tries to assign a financial value to the carbon stored in trees to help developing countries invest in low-carbon paths to sustainable development. REDD+ includes an added focus on conservation, sustainable management of forests, and enhancement of forest carbon stocks. Externalities10Buchanan JM Stubblebine WC Externality.Economica. 1962; 29: 371-384Crossref Google Scholar A benefit or cost that affects an individual or group of people who did not choose to incur that benefit or cost. Circular economy11European CommissionTowards a circular economy: a zero waste programme for Europe.http://eur-lex.europa.eu/legal-content/EN/TXT/?uri=CELEX:52014DC0398Date: 2014Google Scholar A global economic model that decouples economic growth and development from the consumption of finite resources. Circular economy systems keep products in use for as long as possible, allow for the recycling of end products, and eliminate waste. State shift12Rocha JC Biggs R Peterson GD Regime shifts: what are they and why do they matter?.http://www.regimeshifts.org/datasets-resources/Date: 2014Google Scholar Large, lasting changes in the structure and function of social–ecological systems, with substantial impacts on the ecosystem services provided by these systems. Resilience8Stockholm Resilience CentreResilience dictionary.http://www.stockholmresilience.org/21/research/what-is-resilience/resilience-dictionary.htmlDate: 2015Google Scholar, 13Rodin J The resilience dividend: being strong in a world where things go wrong. PublicAffairs, New York2014Google Scholar “the capacity of any entity—an individual, a community, an organization, or a natural system—to prepare for disruptions, to recover from shocks and stresses, and to adapt and grow from a disruptive experience.” The growth in urban populations emphasises the importance of policies to improve health and the urban environment, such as through reduced air pollution, increased physical activity, provision of green space, and urban planning to prevent sprawl and decrease the magnitude of urban heat islands. Transdisciplinary research activities and capacity need substantial and urgent expansion. Present research limitations should not delay action. In situations where technology and knowledge can deliver win–win solutions and co-benefits, rapid scale-up can be achieved if researchers move ahead and assess the implementation of potential solutions. Recent scientific investments towards understanding non-linear state shifts in ecosystems are very important, but in the absence of improved understanding and predictability of such changes, efforts to improve resilience for human health and adaptation strategies remain a priority. The creation of integrated surveillance systems that collect rigorous health, socioeconomic, and environmental data for defined populations over long time periods can provide early detection of emerging disease outbreaks or changes in nutrition and non-communicable disease burden. The improvement of risk communication to policy makers and the public and the support of policy makers to make evidence-informed decisions can be helped by an increased capacity to do systematic reviews and the provision of rigorous policy briefs. Health professionals have an essential role in the achievement of planetary health: working across sectors to integrate policies that advance health and environmental sustainability, tackling health inequities, reducing the environmental impacts of health systems, and increasing the resilience of health systems and populations to environmental change. Humanity can be stewarded successfully through the 21st century by addressing the unacceptable inequities in health and wealth within the environmental limits of the Earth, but this will require the generation of new knowledge, implementation of wise policies, decisive action, and inspirational leadership. By most metrics, human health is better today than at any time in history. Life expectancy has soared from 47 years in 1950–1955, to 69 years in 2005–2010. Death rates in children younger than 5 years of age worldwide decreased substantially from 214 per thousand live births in 1950–1955 to 59 in 2005–2010.14You D Hug L Chen Y Wardlaw T Newby H Levels and trends in child mortality. United Nations Inter-agency Group for Child Mortality Estimation, New York2014Google Scholar, 15Population Division of the Department of Economic and Social Affairs of the UN SecretariatWorld population prospects: the 2012 revision. United Nations, New York2013Crossref Google Scholar Human beings have been supremely successful, staging a “great escape” from extreme deprivation in the past 250 years.16Deaton A The great escape: health, wealth, and the origins of inequality. Princeton University Press, Princeton2013Google Scholar The total number of people living in extreme poverty has fallen by 0·7 billion over the past 30 years, despite an increase in the total population of poor countries of about 2 billion.17Olinto P Beegle K Sobrado C Uematsu H The state of the poor: where are the poor, where is extreme poverty harder to end, and what is the current profile of the world's poor? The World Bank, Washington, DC2013Google Scholar This escape from poverty has been accompanied by unparalleled advances in public health, health care, education, human rights legislation, and technological development that have brought great benefits, albeit inequitably, to humanity. Humanity's progress has been supported by the Earth's ecological and biophysical systems. The Earth's atmosphere, oceans, and important ecosystems such as forests, wetlands, and tundra help to maintain a constant climate, provide clean air, recycle nutrients such as nitrogen and phosphorus, and regulate the world's water cycle, giving humanity freshwater for drinking and sanitation.3Millennium Ecosystem AssessmentEcosystems and human wellbeing: health synthesis.in: Corvalan C Hales S McMichael AJ Island Press, Washington DC2005Google Scholar The land, seas, and rivers, and the plants and animals they contain, also provide many direct goods and benefits—chiefly food, fuel, timber, and medicinal compounds (figure 1). 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Food and Agriculture Organization, Rome2014Google Scholar In the quest for energy and control over water resources, humanity has dammed more than 60% of the world's rivers,28World Commission on DamsDams and development: a new framework for decision-making.http://www.unep.org/dams/WCD/report/WCD_DAMS%20report.pdfDate: November, 2000Google Scholar affecting in excess of 0·5 million km of river.29Lehner B Liermann CR Revenga C et al.High-resolution mapping of the world's reservoirs and dams for sustainable river-flow management.Front Ecol Environ. 2011; 9: 494-502Crossref Scopus (0) Google Scholar Humanity is driving species to extinction at a rate that is more than 100 times that observed in the fossil record30Pimm SL Jenkins CN Abell R et al.The biodiversity of species and their rates of extinction, distribution, and protection.Science. 2014; 344: 1246752Crossref PubMed Scopus (1212) Google Scholar and many remaining species are decreasing in number. 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Cambridge University Press, Intergovernmental Panel on Climate Change, Cambridge, UK and New York, USA2013Google Scholar As a consequence of these actions, humanity has become a primary determinant of Earth's biophysical conditions, giving rise to a new term for the present geological epoch, the Anthropocene (panel 1).2Crutzen PJ Geology of mankind.Nature. 2002; 415: 23Crossref PubMed Scopus (1931) Google Scholar In 2005, a landmark study by the Millennium Ecosystem Assessment (MEA) estimated that 60% of ecosystem services examined, from regulation of air quality to purification of water, are being degraded or used unsustainably (figure 2).3Millennium Ecosystem AssessmentEcosystems and human wellbeing: health synthesis.in: Corvalan C Hales S McMichael AJ Island Press, Washington DC2005Google Scholar The authors of the MEA warned that “the ability of the planet's ecosystems to sustain future generations can no longer be taken for granted”.31Millennium Ecosystem AssessmentLiving beyond our means. 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