Planetary health and the 2020 US election
Authors: Howard Frumkin, Samuel S Myers
Journal: The Lancet (2020)

Elections impact health through changes in both health-care delivery1Galea S Ettman CK Abdalla SM Access to health care and the 2020 US election.Lancet. 2020; 396: 803-805Summary Full Text Full Text PDF PubMed Scopus (1) Google Scholar and upstream social and environmental policies. The upcoming US election presents stark contrasts in environmental policies that will affect health in the USA and globally. Here we examine these contrasts through the lens of planetary health.2Myers S Frumkin H Planetary health: protecting nature to protect ourselves. Island Press, Washington, DC2020Crossref Google Scholar A hallmark of the current US administration has been its hostility to environmental stewardship and its embrace of an antiregulatory agenda. President Donald Trump has appointed administration officials from the ranks of polluting industries and their lobbying firms;3Dlouhy JA President Trump nominates acting EPA Chief Andrew Wheeler, a former coal lobbyist, to lead agency.Time. Jan 9, 2019; Google Scholar eviscerated some key government agencies;4Graff GM Trump broke the agencies that were supposed to stop the COVID-19 epidemic.Politico. April 7, 2020; Google Scholar and diluted or overturned environmental regulations (table). Notably, Trump has called climate change a hoax and has cast doubt on established science.5Wong E Trump has called climate change a Chinese hoax. Beijing says it is anything but.The New York Times. Nov 18, 2016; Google Scholar The Democratic presidential candidate, Joe Biden, has stronger pro-environmental positions as evidenced by the actions of the Obama administration in which he served and by his published 2020 election platform on a clean energy revolution and environmental justice.6Biden-Harris CampaignThe Biden Plan for a Clean Energy Revolution and Environmental Justice.https://joebiden.com/climate-plan/#Date: 2020Date accessed: September 24, 2020Google Scholar The candidates' environmental policy positions to date are outlined in the table.TableIllustrative environmental policies of Trump (2017–20) and Biden (projected) administrationsTrump recordBiden platformEnergyWeakened power plant greenhouse gas emission rules; permitted controversial new oil pipelines; lowered barriers to fossil fuel development; weakened methane and volatile organic compound emission rules at drill sites; weakened energy conservation standards for household and commercial appliances"Ensure the US achieves a 100% clean energy economy and reaches net-zero emissions no later than 2050"; would strengthen vehicle fuel economy standards; nationwide programme of energy efficiency in buildings; supports "a worldwide ban on fossil fuel subsidies"WaterRolled back offshore drilling safety rules; removed protection on marine national monuments; rolled back Clean Water Act provisions that protected rivers and streamsWould ban new oil and gas permitting in public waters; would make water infrastructure a top priority including monitoring contaminant levels, and holding polluters accountableLandWeakened wetlands protection; opened more federal land for oil and gas exploitation, mining, and logging; reduced enforcement of illegal grazing on public landsWould ban new oil and gas permitting on public lands; permanently protect Arctic National Wildlife Refuge; advocates reforestation of public landsBiodiversityReduced wildlife protections; weakened Endangered Species Act"Protecting biodiversity, slowing extinction rates and helping leverage natural climate solutions by conserving 30% of America's lands and waters by 2030"Food and agricultureWithdrew organic livestock animal welfare rule; exempted combined animal feed operations from hazardous substance release reporting requirements"Invest in climate-friendly farming such as conservation programs for cover crops and other practices aimed at restoring the soil and building soil carbon, and in the process, preventing run-off and helping family farmers deploy the latest technologies to maximize productivity"Chemical pollutionBlocked or weakened regulations of power plant mercury and other toxic emissions, chlorpyrifos, and other chemicals; weakened rules on coal ash wastePledges to strengthen enforcement of pollution rules, especially in disproportionately impacted communitiesTransportCut funding for rail, urban transit, and pedestrian and bicycle infrastructure, while heavily funding highways; weakened vehicle fuel efficiency standards; revoked California's right to set strict vehicle emission standards; exempted oil refiners from biofuel blending requirementsSupports local solutions for transit and pedestrian and bicycle infrastructure; pledges a "second great railroad revolution" with substantial expansion of rail infrastructure; would accelerate deployment of electric vehicles through charging infrastructure and tax creditsRole of scienceWeakened and/or disbanded science advisory groups; defunded NASA monitoring of carbon emissions; proposed EPA transparency rule precludes use of much health evidence in policy makingDeclared commitment to "science, not fiction"International cooperationWithdrew from Paris Agreement; ended US funding for WHO; reinstated Mexico City Policy ("global gag rule"), blocking US funding of NGOs that provide abortion services or advocate for abortionPledges to lead global efforts to ramp up climate targets; would rejoin Paris Agreement; would promote low-carbon international development aid; would withdraw Mexico City PolicyEPA=Environmental Protection Agency. NGOs=non-governmental organisations. Extended table and sources are in the appendix. Open table in a new tab EPA=Environmental Protection Agency. NGOs=non-governmental organisations. Extended table and sources are in the appendix. Climate change policy provides one of the sharpest distinctions between Trump and Biden. Climate change has extensive health implications through pathways that include severe weather events, infectious disease spread, hunger and reduced nutrition, mental health effects, and forced migration and conflict.7WHOCOP24 special report: health and climate change. World Health Organization, Geneva2018Google Scholar The Trump administration's denial of climate science, withdrawal from the Paris Accords, and dismantling of climate policy increase the risk of these outcomes in the USA and globally.8Cutler D Dominici F A breath of bad air: cost of the Trump environmental agenda may lead to 80 000 extra deaths per decade.JAMA. 2018; 319: 2261-2262Crossref PubMed Scopus (23) Google Scholar, 9Pitt H Larsen K Young M The undoing of US climate policy: the emissions impact of Trump-era rollbacks. Rhodium Group, New York2020Google Scholar By contrast, Biden's proposed climate change policies would be expected to yield health benefits; mitigation action delivers health co-benefits10Gao J Kovats S Vardoulakis S et al.Public health co-benefits of greenhouse gas emissions reduction: a systematic review.Sci Total Environ. 2018; 627: 388-402Crossref PubMed Scopus (93) Google Scholar, 11Milner J Hamilton I Woodcock J et al.Health benefits of policies to reduce carbon emissions.BMJ. 2020; 368l6758Crossref PubMed Scopus (41) Google Scholar and adaptation, such as disaster planning, heatwave preparedness, and planned relocation, can reduce human suffering.12Adger WN Lorenzoni I O'Brien KL Adapting to climate change: thresholds, values, governance. Cambridge University Press, Cambridge2009Google Scholar, 13Moser SC Boykoff MT Successful adaptation to climate change: linking science and policy in a rapidly changing world. Routledge Taylor & Francis Group, London2013Crossref Scopus (11) Google Scholar The growing field of planetary health makes clear that other areas of environmental policy impact on health.2Myers S Frumkin H Planetary health: protecting nature to protect ourselves. Island Press, Washington, DC2020Crossref Google Scholar Protection of terrestrial and marine biodiversity may limit infectious disease exposure, promote mental health, facilitate pharmaceuticals discovery, and improve nutrition.14Romanelli C Cooper D Campbell-Lendrum D et al.Connecting global priorities: biodiversity and human health. A state of knowledge review. UN Environment Programme, Convention on Biological Diversity, World Health Organization, Geneva2015Google Scholar Protecting the recreational, cultural, and spiritual value of access to undisturbed public lands has a role in supporting mental and physical health.15Bratman GN Anderson CB Berman MG et al.Nature and mental health: an ecosystem service perspective.Sci Advances. 2019; 5eaax0903Crossref PubMed Scopus (857) Google Scholar, 16Hermes J Van Berkel D Burkhard B et al.Assessment and valuation of recreational ecosystem services of landscapes.Ecosys Serv. 2018; 31: 289-295Crossref PubMed Scopus (110) Google Scholar Safeguarding human health from pollution of air, water, and soil was a core reason for establishing the US Environmental Protection Agency (EPA) in 1970, and the Trump administration's weakening of these safeguards puts Americans at increased risk of cardiorespiratory disease, endocrine and neurobehavioural abnormalities, and some cancers.17Landrigan PJ Fuller R Acosta NJR et al.Report of the Lancet Commission on pollution and health.Lancet. 2018; 391: 462-512Summary Full Text Full Text PDF PubMed Scopus (2661) Google Scholar Some of the health consequences of post-election environmental policies will be felt in the near term, whereas others will be delayed. For example, adaptation actions such as pandemic preparedness are expected to be stronger under a Biden presidency than under a Trump presidency, as shown by the current administration's COVID-19 response. Action to reduce emissions from power plants and motor vehicles can yield reduced air pollution, and health benefits, within months to years. But some health benefits of policies that conserve land, water, and biodiversity will only manifest over many years. The environmental policies that are pursued after this election will be felt in the USA and globally. Actions to protect rivers and streams, for example, will mainly benefit those in the affected watersheds, and continued soil loss will compromise local agriculture. But persistent toxic chemical emissions do not remain in place;17Landrigan PJ Fuller R Acosta NJR et al.Report of the Lancet Commission on pollution and health.Lancet. 2018; 391: 462-512Summary Full Text Full Text PDF PubMed Scopus (2661) Google Scholar they circulate globally in processes that are accelerating with climate change.18Wang X Sun D Yao T Climate change and global cycling of persistent organic pollutants: a critical review.Sci China Earth Sciences. 2016; 59: 1899-1911Crossref Scopus (70) Google Scholar The health implications of promoting versus obstructing climate action will be felt worldwide and across future generations. Although a Biden presidency would be expected to advance planetary health more than a second Trump term, there are likely to be limits to these benefits. First, Biden's policies do not go far enough for many environmentalists. For example, unlike some of his opponents in the Democratic Party presidential primary race, Biden has stopped short of promising to ban fracking, despite its direct and indirect adverse health effects.19Landrigan PJ Frumkin H Lundberg BE The false promise of natural gas.New Engl J Med. 2020; 382: 104-107Crossref PubMed Scopus (20) Google Scholar Critics have pointed to Biden's continued reliance on advisers associated with the Obama administration's "all of the above" energy strategy, some with links to the fossil fuel industry.20Litwak M Moran M On climate policy, Biden's advisers reveal more than his proposals do.The Intercept. Aug 7, 2020; Google Scholar Second, although the US President has considerable power through agency appointments and executive orders, legislative solutions and budgeting rest with the US Congress. A Republican majority in either or both houses of Congress could stymie progress. Third, many US environmental policies face legal challenges and Trump has established a highly conservative judiciary. This is a fraught historical moment. In the months leading up to the 2020 election, fires have consumed more than 7 million acres of western forests in the USA. Hurricanes in the Atlantic and the Gulf of Mexico led to the deaths of over 100 Americans in states from North Carolina to Texas, and caused more than US$20 billion in damages.21Center for Disaster Philanthropy2020 Atlantic hurricane season. Center for Disaster Philanthropy, Washington, DC2020Google Scholar Efforts to move people to safety from these disasters have been hampered by the COVID-19 pandemic. These emergencies arise in the context of the larger global climate emergency. According to the Intergovernmental Panel on Climate Change, the window for reductions in greenhouse gas emissions to avoid catastrophic climate change is rapidly closing.22IPCCGlobal warming of 1.5°C. An IPCC Special Report on the impacts of global warming of 1.5°C above pre-industrial levels and related global greenhouse gas emission pathways, in the context of strengthening the global response to the threat of climate change, sustainable development, and efforts to eradicate poverty. Intergovernmental Panel on Climate Change, World Meteorological Organization, Geneva2018Google Scholar Similarly, the Intergovernmental Science-Policy Platform on Biodiversity and Ecosystem Services warns that there is only a short time to act on threats to biodiversity.23IPBESSummary for policymakers of the global assessment report on biodiversity and ecosystem services of the Intergovernmental Science-Policy Platform on Biodiversity and Ecosystem Services. Intergovernmental Science-Policy Platform on Biodiversity and Ecosystem Services Secretariat, Bonn2019Google Scholar Continued reliance on fossil fuels, destruction of ecosystems, dissemination of persistent toxic chemicals, and other environmental depredations—many of them permitted, if not promoted, during the Trump presidency—are inconsistent with a healthy future for humanity. The alternative is a transition to ways of living that protect both natural systems and the health of current and future generations. This path requires new approaches to generating energy, producing and consuming food, chemicals, and other manufactured goods, travelling, and designing and building cities. The vast public investments some governments are making during the COVID-19 pandemic could spur this transition,24WHOWHO manifesto for a healthy recovery from COVID-19. World Health Organization, Geneva2020https://www.who.int/docs/default-source/climate-change/who-manifesto-for-a-healthy-and-green-post-covid-recovery.pdfDate accessed: September 25, 2020Google Scholar and US leadership could be catalytic. The outcome of the US election will have far-reaching consequences for planetary health. We declare no competing interests. Download .pdf (.12 MB) Help with pdf files Supplementary appendix