What's planetary about health? An analysis of topics covered in The Lancet Planetary Health 's first year
Authors: Jennifer Cole, Sam Bickersteth
Journal: The Lancet Planetary Health (2018)

Since its launch in April, 2017, The Lancet Planetary Health has aimed to build on the foundation of The Rockefeller Foundation-Lancet Commission on planetary health.1Whitmee S Haines A Beyrer C et al.Safeguarding human health in the Anthropocene epoch: report of The Rockefeller Foundation–Lancet Commission on planetary health.Lancet. 2015; 386: 1973-2028Summary Full Text Full Text PDF PubMed Scopus (1152) Google Scholar The journal describes itself as, "committed to publishing high-quality original research Articles, Editorials, Comments, and Correspondence that cover the interplay between health and the determinants of health in our living and physical world"; so, has it achieved this? We studied the abstracts of articles covered in the first year of publication (April, 2017 to March, 2018) to assess the extent to which human health, the health of the environment, and sociopolitical aspects of health challenges (by use of political, economic, social, technical, legal, and ethical [PESTLE] categorisation) were covered within the same article. Our aim was to map the topics considered to fall within the emerging field of planetary health, to quantify the interest in individual topics on the basis of topics that are covered most often, and to identify the topics that are frequently linked together within articles (eg, climate change and disease; appendix). In the first 12 issues, 113 papers were published of which five were short commentary papers providing an introduction or summary to a longer article in the same issue. This left 108 unique topic papers of which 103 referred to human health in the Summary, 102 referred to the health of the environment, 92 included a PESTLE consideration, 98 referred to both human health and the health of the environment but not PESTLE, 87 referred to human health and PESTLE but not the health of the environment, 86 referred to the health of the environment and PESTLE but not human health, and 81 referred to all three meta-topic areas. Topics featured frequently in the abstracts included air pollution, greenhouse gas emissions, temperature rise, transport emissions, diet, and food systems. Additionally, social effects were mentioned 36 times, the need for political action mentioned 23 times, and the role (or potential role) of environmental protection mentioned 18 times. The approach taken by most authors was to focus on a single driver of environmental harm (eg, greenhouse gas emissions) and relate this to a number of human health effects (eg, respiratory conditions, cardiovascular conditions, low birthweight, and dementia). There was less evidence of authors focussing on a specific condition and determining the entire range of environmental drivers that might affect it. Diseases were often covered in terms of environmental factors that influence emergence and spread, such as changes in disease distribution due to altered vector habitats,2Janko MM Irish SR Reich BJ et al.The links between agriculture, Anopheles mosquitoes, and malaria risk in children younger than 5 years in the Democratic Republic of the Congo: a population-based, cross-sectional, spatial study.Lancet Planet Health. 2018; 2: e74-e82Summary Full Text Full Text PDF PubMed Scopus (29) Google Scholar the effect of intensive livestock farming on the emergence of antimicrobial resistance,3Asaduzzaman M Antimicrobial resistance: an urgent need for a planetary and ecosystem approach.Lancet Planet Health. 2018; 2: e99-e100Summary Full Text Full Text PDF PubMed Scopus (7) Google Scholar and the effect of pathogens on human health or PESTLE aspects. Articles frequently linked respiratory conditions to poor air quality including, cardiovascular disease and diabetes to air pollution and poor diet,4Poore KR Hanson MA Faustman EM Neira M Avoidable early life environmental exposures.Lancet Planet Health. 2017; 1: e172-e173Summary Full Text Full Text PDF PubMed Scopus (6) Google Scholar and mental health issues to reduced access to nature and to climate change-driven migration. Non-communicable diseases received more than twice as much coverage as communicable diseases. Heat stress resulting from climate change also featured in a number of articles. Papers that included a PESTLE focus recommended influencing behavioural change towards protection of the environment to reduce the effect on health,5Acunzo DJ Escher G Ottersen OP et al.Framing planetary health: arguing for resource-centred science.Lancet Planet Health. 2018; 2: e101-e102Summary Full Text Full Text PDF PubMed Scopus (4) Google Scholar promoting the role of public health professionals to inspire interest in planetary health and encouraging education of health professionals to mitigate negative effects. Several papers highlighted the inequalities in low-income and middle-income countries and the link between degraded socioeconomic conditions and health outcomes. Climate change, water, and land use were seen to have major influence on human health and the health of the environment through greenhouse gas emissions, air pollution, agricultural processes, food systems, transport systems, and biodiversity loss. PESTLE considerations were framed as both a cause of (eg, population increase) and a solution to (eg, strengthened environmental protection) these challenges. This framing suggests that planetary health has a practical, action-oriented focus that goes beyond academic understanding and monitoring of the challenges. Planetary health seeks to identify and propose workable solutions; for example, by drawing attention to links between air pollution and non-communicable diseases, environmental protection legislation can be positioned as a potential health solution. Linking rising temperatures from climate change to heat stress effects on populations and increases in displacement (with attendant mental health issues) due to extreme weather events also highlights the need for social and political action. Social cohesion and well managed disaster relief, for example, becomes a mitigation for the health effects of climate change. The association between food systems, nutritional quality, and obesity-related diseases such as diabetes and heart disease were a third nexus, requiring behavioural change that might need strong regulation and legislation of food systems. Our analysis suggests that for an article to be considered relevant to planetary health it should include elements of human health, environmental health, and PESTLE, covering not only the intersection of human and environmental health, but also the socioeconomic contexts that influence both human and environmental health. This observation points towards a forward-facing, action-oriented approach that seeks solutions through social, political, and economic tools, rather than one that simply presents the problem space. Examples include a need for strong environmental protection to protect water sources essential for health;6Guitton MJ The water challenges: alternative paths to trigger large-scale behavioural shifts.Lancet Planet Health. 2017; 1: e46-e47Summary Full Text Full Text PDF PubMed Scopus (5) Google Scholar the role of well designed, affordable, and environment-appropriate housing to provide health protection against increasing risks from heat stress and malaria driven by climate change;7von Seidlein L Ikonomidis K Mshamu S et al.Affordable house designs to improve health in rural Africa: a field study from northeastern Tanzania.Lancet Planet Health. 2017; 1: e188-e199Summary Full Text Full Text PDF PubMed Scopus (44) Google Scholar and the need for strong control of particulate matter emissions to reduce air pollution and prevent increasing incidence of kidney disease.8Landrigan PJ Air pollution and the kidney—implications for control of non-communicable diseases.Lancet Planet Health. 2017; 1: e261-e262Summary Full Text Full Text PDF PubMed Scopus (7) Google Scholar Although papers often proposed a challenge or solution interface on linked human health, health of the environment, and PESTLE topics (such as vector habitat changes driving the spread of infectious diseases requiring environmental protection), there was less coverage of applied or theoretical technological solutions, which could be a weakness of the current approach. Increased attention should be focused on the economic and political toolkits that might be developed to address the challenges, and on how to better support and incentivise areas of potential benefit to planetary health, such as the circular economy, improved monitoring and surveillance, green energy initiatives, and green urban planning. Reaching out to and engaging with potential solution providers could be a valuable short-term activity for the planetary health community. We declare no competing interests Download .xlsx (.04 MB) Help with xlsx files Supplementary appendix