Operationalising planetary health as a game-changing paradigm: health impact assessments are key

Abstract

We have watched with excited astonishment how relatively quickly the planetary health1Whitmee S Haines A Beyrer C et al.Safeguarding human health in the Anthropocene epoch: Report of The Rockefeller Foundation–Lancet Commission on Planetary Health.Lancet. 2015; 386: 1973-2028Summary Full Text Full Text PDF PubMed Scopus (1122) Google Scholar paradigm has gained traction with major foundations, the UN system, and a wide range of actors in the public health2Almada AA Golden CD Osofsky SA Myers SS A case for planetary health/geohealth.GeoHealth. 2017; 1: 75-78Crossref PubMed Scopus (17) Google Scholar and environmental conservation3Redford KH Myers SS Ricketts TH Osofsky SA Human health as a judicious conservation opportunity.Conserv Biol. 2014; 28: 627-629Crossref PubMed Scopus (9) Google Scholar realms. The appeal is obvious: two of the great sustainability challenges humanity faces—the future of our health and the health of the natural systems we all depend upon—remain worryingly unaddressed.4Ripple WJ Wolf C Newsome TM et al.World scientists' warning to humanity: a second notice.BioScience. 2017; 67: 1026-1028Crossref Scopus (597) Google Scholar Planetary health offers an integrative approach to further develop an evidence base to inform solutions that simultaneously address human health, environmental sustainability, and economic development. The need for bold, transformative actions to protect present and future generations, the foundational catalyst for planetary health as a field, is obvious and urgent. Planetary health, in terms of an operational definition, is a field focused on improving the understanding of, and ability to measure, the public health impacts of anthropogenic environmental change, so as to inform decision-making in the land-use planning, ocean-use planning, environmental conservation, and public health policy realms. As other commentators have noted, what cannot be measured cannot be managed. The type of transdisciplinary work that planetary health by its nature demands can help in efforts to ensure that the public health consequences of natural resource management decisions get explicitly factored into these decisions at a range of scales, instead of remaining in the realm of vague and poorly quantified externalities.5Myers SS Gaffikin L Golden CD et al.Human health impacts of ecosystem alteration.Proc Natl Acad Sci USA. 2013; 110: 18753-18760Crossref PubMed Scopus (268) Google Scholar Now more than ever, the question arises of how planetary health can most pragmatically get real world traction and catalyse a proactive, science-based way forward. In short, how can the concept be applied to maximum effect, as a go-to tool in the global problem-solving toolbox in support of the UN 2030 Agenda for Sustainable Development? We propose that a key response to these questions would be the formal adoption of the Health Impact Assessment (HIA) concept at a wide range of scales. The HIA concept is not new,6National Research CouncilImproving health in the United States: the role of health impact assessment.https://www.nap.edu/catalog/13229/improving-health-in-the-united-states-the-role-of-healthGoogle Scholar but it is an idea whose time has clearly come.7Lock K Health impact assessment.BMJ. 2000; 320: 1395-1398Crossref PubMed Scopus (137) Google Scholar As described previously,7Lock K Health impact assessment.BMJ. 2000; 320: 1395-1398Crossref PubMed Scopus (137) Google Scholar “Health impact assessment is a means of evidence based policy making for improvement in health. It is a combination of methods whose aim is to assess the health consequences to a population of a policy, project, or programme that does not necessarily have health as its primary objective. Health impact assessment is a multidisciplinary process within which a range of evidence about the health effects of a proposal is considered in a structured framework. It takes into account the opinions and expectations of those who may be affected by a proposed policy. Potential health impacts of a proposal are analysed and used to influence the decision making process.” If planetary health is going to meet our aspirations for it as a (long-overdue) working framework for integrated decision making,8Pongsiri MJ Gatzweiler FG Bassi AM et al.The need for a systems approach to planetary health.Lancet Planet Health. 2017; 1: e257-e259Summary Full Text Full Text PDF PubMed Scopus (35) Google Scholar it is imperative that the growing understanding of planetary health relationships be directly and expeditiously applied. This could undoubtedly be jump-started if global, national, and local institutions implement HIAs to account for the crucial interconnections between the condition of natural systems and public health, as measured, for example, in dollars or disability-adjusted life-years. The inclusive process that characterises a robust HIA builds a shared understanding of likely human health impacts of a pending policy, plan or project. In a