Planetary Health and the Role of Nursing: A Call to Action

The concept of human endeavor grouped under the rubric of global health has evolved over time. Following a quasicolonial model of tropical medicine that tended to focus on single diseases and achievements such as the eradication of smallpox, in the mid-20th century the term became international health-arguably still an "us and them" framing (Brown, Cueto, & Fee, 2006). By the 2000s there was a move to define global health in a way that embraced the interconnectedness of human communities, as "... an area for study, research, and practice that places a priority on improving health and achieving equity in health for all people worldwide" (Koplan et al., 2009, p. 1995).Health Improvements and ConsequencesThe United Nations' (UN) millennium development goals (MDGs) were a further milestone in the evolution of global health. MDGs were established with focused, quantifiable health goals, though their conceptual focus was only on low-income countries (Office of the High Commissioner for Human Rights [OHCHR], n.d.). By 2015, all 193 UN member countries transitioned from the MDG framework into sustainable development goals (SDGs) that are much broader (17 goals, 169 targets), intersectoral (beyond health), and apply to all countries, whether high-income country (HIC) or low- or middle-income country (LMIC) status (World Health Organization [WHO], 2015).SDG 3, good health and well-being, includes newborn and maternal mortality goals, targets for reduction of noncommunicable diseases (NCDs), universal access to sexual and reproductive healthcare services, health workforce goals, and reduction of deaths and illness from environmental pollutants, among others (UN, n.d.).Growing concern that economic development gains are undermined by humans' transformation of the planet brought focus within the SDG framework to the coupled priorities of environmental protection and poverty reduction (Griggs et al., 2013). The 17 SDGs in total outline goals for climate action, reduced inequalities, clean energy, and the achievement of equality and justice. Tacit recognition of health as a human right has driven a focus within the framework on equity, economies, and ecology (OHCHR, n.d.).The One Health Initiative, a "worldwide strategy for expanding interdisciplinary collaborations and communications in all aspects of health care for humans, animals, and the environment," is a milestone coalition and movement built upon older concepts of zoonotic disease and the connection between public health and the environment (One Health Initiative, n.d., para.1). And now many have begun to talk about planetary health, an organizing focus on health that considers both the benefits and the untoward consequences of economic development.These organizing frameworks are occurring in the context of major global health trends. NCDs continue to grow at an alarming, rapid rate, including in LMICs. Urbanization is another clear trend. In 2007, more humans around the globe lived in cities than in rural areas, and predictions are that by 2050 another 2.5 billion people will live in cities, with 90% of this change occurring in Asia and Africa. By mid-century, 66% of the world's population will be urban (UN, 2014). The number of people living in slums now approaches 1 billion, with projections indicating that number will double by 2030. If that prediction holds, most of the growth in human population in the next 15 years will be into urban slums through migration and natural growth (United Nations Human Settlements Programme, n.d.).Global urbanization trends suggest growth in social and health inequality. Data from urban health researchers consistently demonstrate a monotonic positive association between measures of concentrated disadvantage and poor health outcomes (Vlahov et al., 2007). Urban areas are at the center of globalization, with the transmission of capital and innovation, but also at the center of transmission of energy use, infectious disease transmission, and pollution. …