Weighing the risks
Authors: None The Lancet Planetary Health
Journal: The Lancet Planetary Health (2020)

Every year, the World Economic Forum (WEF) releases a Global Risk Report in an effort to integrate the major risks posed to society over the coming decade. The report is based upon a poll of WEF members and a wider stakeholder group—for the 2020 report, the survey included around 1000 representatives from business, government, academia, and civil society. This exercise provides a common framework in which to compare diverse risks, from asset bubbles to weapons of mass destruction and extreme weather events. Risks are categorised in terms of their impact and likelihood and presented on a matrix with those that are most concerning (with high impact and high likelihood) at the top right of the matrix. In the 2020 report, environmental risks dominate this “corner of most concern”, making up the top five risks by likelihood (“extreme weather events”, “climate action failure”, “natural disasters”, “biodiversity loss” and “human-made environmental disasters”) and the first, third and fourth top risks by impact. The WHO undertook a comparable exercise to list 13 “Urgent global health challenges for the 2020s”. Although this list is not ranked, threats directly or indirectly related to the state of the environment feature strongly, notably including the need to elevate health in the climate debate. Nine out of ten people are exposed to polluted air every day leading to an estimated 7 million premature deaths per year. Climate change is expected to cause increasingly negative health outcomes through a host of effects such as increases in malnutrition, the spread of vector-borne disease, and heat stress. Air pollution and climate change are intimately linked through the burning of fossil fuels which are primarily responsible for both phenomena. Climate policies require steep declines in fossil fuel use and this could go a long way towards improving air quality. So far, so unsurprising. These two recent efforts further highlight that the environment is now a major risk to lives and livelihoods, rather than being some abstract object of moral concern. From an academic perspective, we have arrived at this insight via enormous strides in understanding of the complexities of natural systems and the ways in which they are impacted by, and can impact upon, people. In short, we have already identified many of the health and sustainability challenges of our time and how they interconnect. We know the major causes and we know in broad terms what we need to do to improve things. Regrettably, both of these reports also contain insights into why progressing from knowledge to action is so often difficult in practice. A notable entry in the WHO list is “Earning public trust”. Public health is being compromised by the dissemination of misinformation through social media, and the erosion of trust in public institutions, the anti-vaccination movement has also contributed to a rise in deaths from preventable diseases. The reasons for vaccine hesitancy are complex, and factors identified include inconvenience of access, lack of confidence and complacency (many of these diseases are now relatively rare precisely because of vaccination). The lack of confidence is particularly concerning given that vaccination is a long proven and extremely cost-effective health intervention. The rise of vaccine hesitancy seems to be reflective of wider difficulties in taking robust academic knowledge through to public acceptance and practical application. The basic problem of moving from knowledge to action is not new; time and again vested interest has been able to combat overwhelming evidence to push a competing agenda. However, the power of evidence to persuade does seem to be at a low point. Perhaps social media should take some of the blame, because of its emphasis on soundbite and the tendency for echo chambers of opinion to emerge. But whatever the cause, we appear to be firmly ensconced in an era of post-truth debate and increasing personal and political populism. This polarisation, combined with the fundamental challenge that living within planetary boundaries poses to the sociopolitical and economic status quo make the process of turning knowledge into real change more challenging even than generating that knowledge in the first place. Much as we need to continue to refine our understanding of key sustainability challenges and map out viable solutions, it is insight into the theoretical and practical means to achieve acceptance and implement change that will most determine planetary health in the coming decades.