# Executive summary Three categories of challenges to maintain and enhance human health in the face of incresaingly harmful environmental trends. 1. Conceptual and empathy failures (imagination challenges): such as overreliance on [[Gross Domestic Product (GDP)]] as a measure of human progress, to failure to account for future health and environmental harms over present day gains, and the disproportionate effect of those harms on the poor and those in developing nations. 2. Knowledge failures (research and information challenges), such as failure to address social and environmental drivers of ill health, a historical scarcity of transdisciplinary research and funding, together with an unwillingness or inability to deal with uncertainty within decision making framework. 3. Implementation failures (governance challenges), such as how governments and institutions delay recognition and responses to threats, especially when faced with uncertainties, pooled common resources, and time lags between action and effect. [[GHM300 Project]] Should we do this? What's the root cause of governance challenge from politicians' perspective? Compare global north and global south countries? This Commission identifies opportunities for action by six key constituencies: health professionals, research funders and the academic community, the UN and Bretton Woods bodies, governments, investors and corporate reporting bodies, and civil society organisations. > [!NOTE] Key messages > 1. The concept of planetary health is based on the understanding that human health and human civilisation depend on flourishing natural systems and the wise stewardship of those natural systems. However, natural systems are being degraded to an extent unprecedented in human history. > 2. Environmental threats to human health and human civilisation will be characterised by surprise and uncertainty. Our societies face clear and potent dangers that require urgent and transformative actions to protect present and future generations. > 3. The present systems of governance and organisation of human knowledge are inadequate to address the threats to planetary health. We call for improved governance to aid the integration of social, economic, and environmental policies and for the creation, synthesis, and application of interdisciplinary knowledge to strengthen planetary health. > 4. Solutions lie within reach and should be based on the redefinition of prosperity to focus on the enhancement of quality of life and delivery of improved health for all, together with respect for the integrity of natural systems. This endeavour will necessitate that societies address the drivers of environmental change by promoting sustainable and equitable patterns of consumption, reducing population growth, and harnessing the power of technology for change. Indeed, the metaphor of the web of causation has often been replaced by a metaphor of pathways. This has meant that thinking systemically has been replaced by linear causality. In addition, human agency and the societal conditions of daily life have not been included in some interdisciplinary research that is meant to improve understanding of the complex relationships between contact with public green spaces, individual and collective behaviours and health. This article has suggested and illustrated a different ontological perspective of people – environment relations which is contextual, dynamic and systemic, and then illustrated its application for addressing this complex subject in the future. “The interconnected nature of people and the planet mean that solutions that benefit both the planet and human health lie within reach. ==Unparalleled opportunities now exist to improve governance, harness new knowledge, and exploit a range of technologies that can improve health and reduce environmental damage.==” (Whitmee et al., 2015, p. 1979) # Conclusions—policy propositions to advance [[Planetary health]] ## Propositions to address imagination (conceptual) challenges To advance planetary health, policies should: 1. Account for depreciation of natural capital and nature's subsidy so that economy and nature are not falsely separated. Policies should balance social progress, environmental sustainability, and the economy. 2. Address unfinished agenda of environmental health challenges, mainly related to poverty, increasing resilience to emerging threats, and tackling the driving forces of environmental change (resource uce, population and technology)—thus enhancing the integrity of the natural systems on which humanity ultimately depends. 3. Facilitate action before irreversible changes in key natural systems occur 4. Scale up resilient food and agricultural systems that address market failures leading to both undernutrition and overnutrition, reduce waste, diversify diets, and minimise environmental impacts. 5. Complement the curative, biomedical, molecular approach to health—which is increasingly reliant on [[precision medicine]]—with a focus on addressing environmental and social roots of ill health through a preventive approach. 6. Develop more resilient health systems, above and beyond the present discourse on universal health coverage, integrating health care and environmental care, particularly at the front-line primary level. Environmental health needs to be integrated into health budgeting and purchasing processes. ## Propositions to address research and information challenges - Expand transdisciplinary research activities and capacity substantially as a matter of urgency. - Address other substantial gaps in knowledge through research such as to define the links between health and environmental change, improve understanding of potential non-linear state shifts in the natural systems underpinning human health, and develop potential adaptation strategies for populations susceptible to environmental change. - Build integrated surveillance systems that collect rigorous health, socioeconomic, and environmental data for defined populations over long time periods to provide early detection of emerging disease outbreaks or changes in nutrition and non-communicable disease burden and to assess the integrated health, environmental, and socioeconomic effect of policies and technologies. - Capitalise on the opportunity of the SDGs to monitor indicators relevant to planetary health in an integrated way and report on progress nationally and internationally. - Document and acknowledge uncertainty, and embrace decision-making frameworks that operate under uncertainty to reduce risks to planetary health. - Improve risk communication to policy makers and the public and to support policy makers to make evidenceinformed decisions, including by increasing capacity to do systematic reviews and provide rigorous policy briefs. ## Propositions to address governance challenges - Achieve improved governance for planetary health through cross-sectoral action at global, national, and subnational levels. Governance should help with a precautionary approach to reduce the risks to health and natural systems in a world where vested interests undermine the political will to act and where inequities have marginalised the voices of many disadvantaged groups. - Implement [[innovative financing|creative financing]]—eg, reduction of harmful subsidies, revenue recycling, payment of providers of ecosystem services, and taxation of polluters—to support rapid transition to a more sustainable world economy than exists at present. - Promote transformative change through combinations of different approaches using a range of regulatory, fi scal, and tax policies; mass media campaigns; and individual behaviour change interventions. - Incentivise and provide evidence-based methods to encourage more robust adherence within the private sector than exists at present to high standards of environmental stewardship and health protection and build capacity in private sector entities based in lowincome and middle-income settings. - Engage civil society and community organisations by promoting public discourse, participation, and transparency of data and systems models to allow monitoring of trends and to encourage polycentric governance building on local capabilities to steward environmental resources and protect health.