The determinants of planetary health
Authors: Nicole Redvers
Journal: The Lancet Planetary Health (2021)

In 2005, the WHO established the Commission on Social Determinants of Health (CSDH), which culminated in a final report in 2008 titled "Closing the gap in a generation".1WHOClosing the gap in a generation: health equity through action on the social determinants of health.https://www.who.int/social_determinants/final_report/csdh_finalreport_2008.pdfDate: Aug 27, 2008Date accessed: December 18, 2020Google Scholar The aims of the Commission were to draw the attention of governments and society to the social determinants of health, and create better social conditions for health, particularly among the most vulnerable people.1WHOClosing the gap in a generation: health equity through action on the social determinants of health.https://www.who.int/social_determinants/final_report/csdh_finalreport_2008.pdfDate: Aug 27, 2008Date accessed: December 18, 2020Google Scholar Since then, distinct areas of importance in individual and community health have been expanded upon in the literature (eg, ecological, biological, behavioural, and geographical determinants of health). The idea that other factors, aside from medical care, influence health was an important steppingstone to expanding understandings of biopsychosocial processes on wellbeing and health outcomes.2Miller GE Chen E Fok AK et al.Low early-life social class leaves a biological residue manifested by decreased glucocorticoid and increased proinflammatory signaling.Proc Natl Acad Sci USA. 2009; 106: 14716-14721Crossref PubMed Scopus (530) Google Scholar Although this body of expanding evidence is incredibly important, it often excludes key determinants that are impactful on Indigenous Peoples' health, such as colonisation as a determinant of health.3Czyzewski K Colonialism as a broader social determinant of health.Int Indig Policy J. 2011; (published online May 16.)https://doi.org/10.18584/iipj.2011.2.1.5Crossref Scopus (107) Google Scholar The determinants of health that have been outlined to date are primarily human centric and describe conditions that impact humans and communities directly, although some, such as the ecological determinants of health, have attributes that seemingly affect both people and planet (a healthy environment is needed to support healthy communities). However, we need to take a truly ecocentric approach in order to understand and clearly conceptualise the determinants of wellbeing for Mother Earth herself (language can be used in a powerful way by framing the planet as the focal point of interest when considering these determinants). Therefore, a new lens could be used to describe and frame the combined factors and conditions that affect the health of the planet; the determinants of planetary health. Factors such as Indigenous land rights, which were highlighted in the 2019 Intergovernmental Panel on Climate Change (IPCC) special report as being critical to safeguarding the world's lands and forests,5IPCCClimate change and land: an IPCC special report on climate change, desertification, land degradation, sustainable land management, food security, and greenhouse gas fluxes in terrestrial ecosystems.https://www.ipcc.ch/srccl/Date: 2019Date accessed: December 18, 2020Google Scholar is a determinant of planetary health. Specific economic structures, the positionality of community, regional and international politics, and colonial mentality are other determinants of planetary health. Ecocentric approaches to planetary health have existed for thousands of years in Indigenous communities, and are necessary to achieve long-term sustainability of the planet.3Czyzewski K Colonialism as a broader social determinant of health.Int Indig Policy J. 2011; (published online May 16.)https://doi.org/10.18584/iipj.2011.2.1.5Crossref Scopus (107) Google Scholar Natural Law, sometimes referred to as First Law, are the original laws of the land for many Indigenous Peoples.6Redvers N Poelina A Schultz C et al.Indigenous natural and first law in planetary health.Challenges. 2020; (published online Oct 28.)https://doi.org/10.3390/challe11020029Crossref Google Scholar These laws embody within them protocols around reciprocity, responsibility, and respect for the planet's wellbeing as a living entity.6Redvers N Poelina A Schultz C et al.Indigenous natural and first law in planetary health.Challenges. 2020; (published online Oct 28.)https://doi.org/10.3390/challe11020029Crossref Google Scholar Framing the determinants of health in relation to these ancient concepts are a way to decolonise current Western dominant paradigms and to gain new perspectives. For too long, humans alone have been the focus when it comes to our understanding of the determinants of health, and it is time to clearly acknowledge and define the determinants of planetary health in a more ecocentric way (ie, with a focus on Mother Earth). A group of Indigenous scholars, Elders, practitioners, and land defenders are currently working to frame the determinants of planetary health from an Indigenous worldview, and we look forward to sharing this work as it progresses. There is clear international discourse around the threat that climate change poses to Indigenous Peoples.7Ford JD Indigenous health and climate change.Am J Public Health. 2012; 102: 1260-1266Crossref PubMed Scopus (114) Google Scholar However, not often emphasised is Indigenous resilience;8Kirmayer LJ Dandeneau S Marshall E Phillips MK Williamson KJ Rethinking resilience from Indigenous perspectives.Can J Psychiatry. 2011; 56: 84-91Crossref PubMed Scopus (240) Google Scholar our global traditional Indigenous knowledge systems are vast and scientific,9Redvers N The science of the sacred: bridging global indigenous medicine systems and modern scientific principles. North Atlantic Books, Berkeley, CA2019Google Scholar but to date our knowledges have been significantly minimised. Indigenous Peoples can bring important long-standing and time-tested research methodologies10Drawson AS Toombs E Mushquash CJ Indigenous research methods: a systematic review.Int Indig Policy J. 2017; (published online March 10.)https://doi.org/10.18584/iipj.2017.8.2.5Crossref Scopus (58) Google Scholar and traditional knowledges to the international climate change discourse. However, our contribution to this global effort will only be as important as the reciprocity, respect, and allyship needed to acknowledge the oldest stewards of the lands. These are lands from which we continue to be forced from globally. Indigenous Peoples currently host, and live in relationship with, more than 80% of the world's biodiversity and yet live on only 20% of the Earth's surface.6Redvers N Poelina A Schultz C et al.Indigenous natural and first law in planetary health.Challenges. 2020; (published online Oct 28.)https://doi.org/10.3390/challe11020029Crossref Google Scholar With continued land evictions, arrests, and killings globally (merely for standing up against mineral and other resource extractions, deforestation, and development), the long-standing history of Indigenous environmental stewardship is at risk of significant loss. This loss will impact us all on Mother Earth. Indigenous Elders around the world are acutely aware of the current crisis we face as a human species regarding global environmental change, including that of climate change. However, they are also acutely aware of how we got here and where we need to go from here. We cannot solve complex problems from the same worldview that created them in the first place, as it will continue to perpetuate a disconnect between us and the planet as 'relatives'. I declare no competing interests.