A roadmap for intergenerational leadership in planetary health
Authors: Zahra Zeinali, Barbara Bulc, Arush Lal, Kim Robin van Daalen, Diarmid Campbell-Lendrum, Tarek Ezzine, Lucy Fagan, Stefan Germann, Renzo Guinto, Heeta Lakhani, Margot Neveux, Christophe Ngendahayo, Poorvaprabha Patil, Sudhvir Singh, Shashank Timilsina, Chiagozie Udeh, Sarah Whitmee
Journal: The Lancet Planetary Health (2020)

Planetary health cannot be achieved without breaking the siloed approach to the most crucial concerns of our time, from the climate emergency, to gender equity, to urbanisation, to the wealth gap—all of which are interconnected and fundamental to human prosperity in the coming decades. Born out of existing structures that are inherently elitist, ageist, and centralised in high-income countries,1Global Health 50/50Power, privilege and priorities: Global Health 50/50 report.https://globalhealth5050.org/2020report/Date: 2020Date accessed: December 19, 2019Google Scholar, 2Dalglish SL COVID-19 gives the lie to global health expertise.Lancet. 2020; 3951189Summary Full Text Full Text PDF PubMed Scopus (81) Google Scholar planetary health often struggles to mitigate the persisting disconnect between various stakeholders and constituents, thus delaying meaningful, lasting impact. It is time to democratise this space, balance the asymmetrical power structures,3The Lancet Global HealthDecolonising COVID-19.Lancet Glob Health. 2020; 8: e612Summary Full Text Full Text PDF PubMed Scopus (11) Google Scholar and leverage fearless voices challenging the status quo. As of 2019, the world has the largest generation of young people in history,4United Nations Youth StrategyYouth 2030: working with and for young people.https://www.un.org/youthenvoy/wp-content/uploads/2018/09/18-00080_UN-Youth-Strategy_Web.pdfDate: Sept 24, 2018Date accessed: December 23, 2019Google Scholar with 1·8 billion people aged between 15–29 years.5United Nations Department of Economic and Social AffairsWorld population prospects 2019: data query.https://population.un.org/wpp/DataQuery/Date accessed: April 18, 2020Google Scholar This demographic is breaking down the boundaries between health and climate disciplines, and modelling the planetary health agenda. With many young people untethered by institutional affiliations, they can unite and operate beyond political or geographical borders with bold voices committed to equity and sustainability. This enables youth to partake in decision making, while ensuring they are intentionally and meaningfully engaged as part of an intergenerational framework. However, young people face many structural barriers when exercising advocacy and leadership, from resistance by authorities, to exclusion from decision making, to blatant tokenisation and siloed youth events. A major issue is the inclusion of a specific privileged fraction of youth at the expense of perspectives from low-income and middle-income countries, Indigenous communities, and nationally marginalised groups. These quick-fix youth engagement solutions limit input from vulnerable populations. To create systemic change, we outline a pragmatic roadmap based on three pillars: governance structures enabling young people's participation, funding that supports inclusion and compensation of young people from all backgrounds, and capacity building for young people. Although these work areas include recent achievement,6WHOEngaging young people for health and sustainable development: strategic opportunities for the World Health Organization and partners.https://www.who.int/life-course/publications/engaging-young-people-for-health-and-sustainable-development/en/Date: 2018Date accessed: December 18, 2019Google Scholar, 7Spajic L Behrens G Gralak S Moseley G Linholm D Beyond tokenism: meaningful youth engagement in planetary health.Lancet Planet Health. 2019; 3: e373-e375Summary Full Text Full Text PDF PubMed Scopus (4) Google Scholar, 8Bulc B Al-Wahdani B Bustreo F et al.Urgency for transformation: youth engagement in global health.Lancet Glob Health. 2019; 7: e839-e840Summary Full Text Full Text PDF PubMed Scopus (13) Google Scholar, 9Lal A Bulc B Bewa MJ et al.Changing the narrative: responsibility for youth engagement is a two-way street.Lancet Child Adolesc Health. 2019; 3: 673-675Summary Full Text Full Text PDF PubMed Scopus (9) Google Scholar, 10The LancetThe emerging voices of youth activists.Lancet. 2019; 3931774Scopus (8) Google Scholar there is an urgent need for further efforts and collaboration. First, emerging entities operating in planetary health should adopt long-term governance mechanisms that create and maintain spaces for young people to share power in decision making and implementation of programmes and policies. Mechanisms include: (1) developing methods to identify existing young professionals and providing a platform for their input; (2) forging long-term partnerships with youth-led networks and organisations and supporting constituency-based engagement; (3) allocating space and time for continuous collaboration instead of one-off consultations without accountability for implementation; (4) facilitating processes for the physical representation of stakeholders where youth are at the centre of the debate; and (5) adopting transparent and equitable selection criteria and procedures for engaging young people. Effective models include UNICEF's child-friendly cities initiative supporting municipal governments in realising the rights of youth at local levels, the UN Major Group for Children and Youth providing a rights-based mechanism for young advocates' input into key sustainable development processes at the UN (including the High-level Political Forum on Sustainable Development, UN General Assembly, and UN Climate Action Summit), the Commonwealth Youth Networks connecting young health and climate activists to their national and local governments to strengthen advocacy and accountability efforts, and Fondation Botnar's Healthy Cities for Adolescents, where adolescent health initiatives are coordinated with a youth council linked to the mayor's office in Thiés, Senegal. Second, creating the infrastructure for long-term, meaningful, and non-tokenistic youth engagement requires allocation of funds enabling youth to engage in processes equitably, travel if necessary, and be remunerated for their time and intellectual work. This should be integrated into existing governance structures to ensure long-term systemic inclusion. Youth are not a homogenous group, and investments must be secured for marginalised young people to engage equitably. Examples of young Indigenous and refugee leaders tackling planetary health issues are promising; however, their efforts often go unrecognised. Furthermore, because a substantial proportion of youth are digital natives, harnessing digital technology is a catalytic opportunity to democratise planetary health. For instance, Fondation Botnar supports initiatives that use digital technologies for youth participation and wellbeing: the OurCity initiative, for example, co-creates programmes that leverage digital systems to transform cities into places where youth's voices and needs are heard and prioritised. Third, young people must be equipped with knowledge and autonomy to meaningfully engage in planetary health. Capacity-building programmes focusing on the many technical planetary health aspects are crucial for young people to provide practical input beyond simply being experts on youth. Medical student associations are focusing on building effective capacity on planetary health by providing training and resources to young people, including the International Federation of Medical Students' Association, the Asian Medical Students Association Nepal, and the Medical Students Association of India. Similarly, the World Obesity Federation's Healthy Voices, a youth-oriented capacity-building platform, provides resources on how young people can tackle obesity in their communities, the World Organization of Family Doctors trains residents and students about air health, and the Next Generation Network of the Planetary Health Alliance provides mentorship and introductory resources to students on various aspects of planetary health. The Rockefeller Foundation-Boston University Commission on Health Determinants, Data, and Decision-making (3-D Commission) exemplifies all three pillars in a fellowship programme for young scholars who are selected through transparent and equitable criteria, provided with mentorship and capacity-building opportunities, and remunerated for their intellectual work. The interconnected nature of planetary health warrants thinking outside silos, by which youth have not yet been bound. Planetary health should set an example for other fields by championing intergenerational leadership across public, private, and civic sectors. Unlocking the potential of more than half of the world's population is only truly possible through the creation of permanent spaces, processes, and platforms for engaging youth.4United Nations Youth StrategyYouth 2030: working with and for young people.https://www.un.org/youthenvoy/wp-content/uploads/2018/09/18-00080_UN-Youth-Strategy_Web.pdfDate: Sept 24, 2018Date accessed: December 23, 2019Google Scholar Planetary health cannot be achieved without inclusive, strong, and sustainable intergenerational leadership and, ultimately, collaboration. For more on UNICEF's child-friendly cities initiative see https://childfriendlycities.org/For more on Fondation Botnar's Healthy Cities for Adolescents see https://www.fondationbotnar.org/the-botnar-healthy-cities-for-adolescents-program/For more on the World Obesity Federation's Healthy Voices platform see https://www.worldobesity.org/healthy-voices For more on UNICEF's child-friendly cities initiative see https://childfriendlycities.org/ For more on Fondation Botnar's Healthy Cities for Adolescents see https://www.fondationbotnar.org/the-botnar-healthy-cities-for-adolescents-program/ For more on the World Obesity Federation's Healthy Voices platform see https://www.worldobesity.org/healthy-voices This online publication has been corrected. The corrected version first appeared at thelancet.com/planetary-health on November 4, 2020 This online publication has been corrected. The corrected version first appeared at thelancet.com/planetary-health on November 4, 2020 After the first four authors, all authors are listed in alphabetical order by last name. We declare no competing interests. We would like to thank Camilla Göth, professional editor from Shape History for editing and reviewing the second draft of this manuscript. Her work was funded by Fondation Botnar. Correction to Lancet Planet Health 2020; 4: e306–08Zeinali Z, Bulc B, Lal A, et al. A roadmap for intergenerational leadership in planetary health. Lancet Planet Health 2020; 4: e306–08—In this Comment, the spelling of Diarmid Campbell-Lendrum's name has been corrected. This correction has been made as of Nov 4, 2020. Full-Text PDF Open Access