Redesigning public health for planetary health
Authors: Astrid Brousselle, Camille Butzbach
Journal: The Lancet Planetary Health (2018)

The current state of planetary health inevitably leads to recognition of the failure of our current models of development, and it constitutes a call for each of us to profoundly revise our frameworks for action. The public health field, with its mission of protecting and promoting health and equity, is at the forefront of such an agenda. However, we are still ignoring the harmful effects of our current recommendations on planetary health. As practitioners and researchers, we need to invest in a new public health ecological approach.1Rayner G Lang T What is the point of public health in the 21st century?.Public Health. 2015; 129: 1309-1313Summary Full Text Full Text PDF PubMed Scopus (3) Google Scholar This change requires both incorporating a new value—sustainability—into our discourse and practices and investing in the strategic political dimension of our role. We propose foundational elements that should be integrated in our practice, to address unprecedented threats to biodiversity and human health. Nowadays, we realise the importance of ecological determinants of health, and how human activity has created an imbalance that has negative consequences for biodiversity. Pollution is considered one of the biggest threats to human life.2Landrigan PJ Fuller R Acosta NJR et al.The Lancet Commission on pollution and health.Lancet. 2017; 391: 462-512Summary Full Text Full Text PDF PubMed Scopus (1963) Google Scholar However, our idea of the role of public health has been focused increasingly on individual health, and the impact of the human footprint on the ecology of our planet (which is the primary determinant of human health), has been neglected. For instance, most national food guides still recommend fish intake as a source of protein. Although sensible at an individual level, such a recommendation is irresponsible when we know that, over the past 50 years, populations of commercially important species of fish have been reduced by 90%.3Pauly D Aquacalypse now: the end of fish.New Republic. 2009; 240: 24-27Google Scholar It is essential that we prioritise sustainability in all of our actions and recommendations. Solutions for building more sustainable societies exist in all sectors: food, housing, transportation, etc. The solutions range from being high tech, to implementing degrowth and supporting local initiatives. The challenge is knowing how to implement these solutions. Public policies have remained unchanged, and we are far from making the drastic changes that are necessary to meet the sustainability agenda.4UNEPThe Emissions Gap Report 2017: A UN Environment Synthesis Report.https://wedocs.unep.org/bitstream/handle/20.500.11822/22070/EGR_2017.pdf?sequence=1&isAllowed=yDate: November, 2017Date accessed: November 30, 2017Google Scholar For example, all industrialised countries that signed the Paris Agreement are failing to reach the targets set by the agreement.4UNEPThe Emissions Gap Report 2017: A UN Environment Synthesis Report.https://wedocs.unep.org/bitstream/handle/20.500.11822/22070/EGR_2017.pdf?sequence=1&isAllowed=yDate: November, 2017Date accessed: November 30, 2017Google Scholar The major cause of this undesired stability is political. Even if people and communities are mobilising in a growing number of localities, (with examples such as the Transition Towns movement) the positive impact of those initiatives is largely undone by macro policies, which are of larger scope.5van den Berg RD Cando-Noordhuizen L Action on climate change: what does it mean and where does it lead to?.in: Uitto JI Puri J Evaluating climate change action for sustainable development. Springer, Cham, Switzerland2017: 13-34Crossref Google Scholar Furthermore, several authors have pointed out that such initiatives seem paradoxically to be maintaining the capitalist paradigm that was causing the problem.6Alloun E Alexander S The transition movement: questions of diversity, power and affluence. Simplicity Institute.http://www.vikalpsangam.org/static/media/uploads/Resources/transitionmovement_simplicity_inst.pdfDate: 2014Date accessed: November 30, 2017Google Scholar, 7Laigle L Pour une transition écologique à visée sociétale.https://www.cairn.info/revue-mouvements-2013-3-page-135.htmDate: 2013Google Scholar What can public health professionals and researchers do? We suggest reinforcing the strategic political dimension of these roles. Several pathways for political action are open to us; we need to consider the political forces and economic interests that influence government decisions, and adopt more strategic action. Commercial interests are strong, and private sector lobbyists have extensive experience in influencing public policy.8Freudenberg N The manufacture of lifestyle: the role of corporations in unhealthy living.J Public Health Policy. 2012; 33: 244-256Crossref PubMed Scopus (33) Google Scholar Building coalitions of actors to move the transition agenda forward could be one option.9Jenkins-Smith HC Nohrstedt D Weible CM Sabatier PA The advocacy coalition framework: foundations, evolution and ongoing research.in: Sabatier PA Weible CM Theories of the Policy Process. 3rd edn. West View Press, Boulder, CO2014Google Scholar Also, an increased effort to shape public opinion is needed. Working with people in communications and in political sciences could help reinforce our actions. The nature of the message that we would like to bring across also needs to be adapted in several aspects. It is our responsibility to frame our discourse differently and make it more accessible. We need to give meaningful and local representations of the impacts of climate change10Bertrand F Amalric M L'élaboration des politiques climatiques locales: usage et portée d'un dispositif de concertation.Développement durable et territoires. 2017; 8: 1-24Google Scholar and relate a positive message to day-to-day life. By showing that solutions exist, we can persuade people that change is possible. Public health has evolved in its approaches over the past century.1Rayner G Lang T What is the point of public health in the 21st century?.Public Health. 2015; 129: 1309-1313Summary Full Text Full Text PDF PubMed Scopus (3) Google Scholar The ecological challenge requires us to profoundly revise our public health policies, to address unprecedented threats to biodiversity and human health. History has shown that such change is possible, but action must be taken, right now. We declare no competing interests.