In July 2014, experts from public, private and research sectors met at the Rockefeller Foundation's "Planetary Health" summit to explore ways to better value ecosystems today to ensure their healthy existence tomorrow.

1. Planetary health
Improving human health by healing the planet
The human health impacts of accelerating global environmental change are likely to be
the biggest humanitarian challenge of this century.
Samuel Myers, research scientist, Harvard School of Public Health
Summary of a meeting hosted by The Rockefeller Foundation
With insights from

2. 2 Planetary Health
Introduction from the Rockefeller Foundation
Since its birth more than 100 years ago, The Rockefeller Foundation has
worked in public health because it believes good health underpins human
progress. Its efforts have ranged from developing the vaccine for Yellow Fever
to strengthening disease surveillance systems to advising several Asian and
African governments on their new Universal Health Care coverage efforts.
Over time, this focus on public health has flowed into work on the Foundation’s
other three “pillars”: improving cities, ecosystems and livelihoods. Bolstering
these pillars, the organization believes, best helps meet its two primary
goals: advancing inclusive economies that expand opportunities for more

3. 3Planetary Health
The Planetary Health meeting was convened by The Rockefeller Foundation and The Lancet
with support from The Rockefeller Foundation.
broadly shared prosperity, and building greater resilience by helping people,
communities and institutions prepare for, withstand and emerge stronger
from acute shocks and chronic stresses.
In this century, the link between environmental change and human health has
become ever more apparent. Malaria is arriving in new places as temperatures
climb. Global environmental change is causing rare plant species to vanish
along with the forests that harbor them. Such plants could be a key ingredient
in a life-saving medicine. The alarming rate at which these changes occur
could have catastrophic consequences not just on our health, but also on the
systems and structures that form the bedrock of humanity. The very survival
of our species and civilization is thus at risk. All this begs the question: What
if the environment is unable to take care of us because we have not taken
care of it?
To consider this interdependency and address the potential health crisis
implied by dramatic environmental change, in July 2014 The Rockefeller
Foundation and British medical journal The Lancet convened a meeting on
“The Future of Planetary Health” at the Foundation’s Bellagio Conference
Center in Italy. More than 30 high-level participants, including scientists,
entrepreneurs, public health experts, business executives and government
leaders met to better understand planetary system disturbances, and to
explore possible solutions to future threats. Insights from the meeting flowed
into a subsequent smaller Rockefeller Foundation–Lancet Planetary Health
Commission meeting.
“The Future of Planetary Health” was the third in the Foundation’s series of
high-level meetings focused on imagining a very different future by 2025
in its four pillar areas. By bringing together diverse, sometimes opposing
perspectives, the Foundation hopes to help develop vital strategies and
solutions that will fortify humanity’s ability to anticipate and adapt to rapidly
emerging opportunities and challenges. For more information on the series,
please go to www.visionariesunbound.com. The Economist Intelligence
Unit wrote this summary report, with the exception of the Introduction and
Conclusion, which were written by The Rockefeller Foundation.

4. 4 Planetary Health
Planetary Health
brought together
more than 30 experts
to explore ways to
improve human health
by healing the planet
Executive Summary
Humanity’s heavy ecological footprint on the planet is well known. Factories, farms,
cars and our consumption patterns have changed the earth and its natural environment
in many irrevocable ways. Far less understood is how these environmental changes
are influencing human health. Signs have surfaced that point to a startling link between
these two areas, and beg for action. These include a rise in the incidence of or exposure
to tropical disease such as Dengue fever as temperatures rise in higher latitudes and
natural habitats like forests disappear, and a rise in famine, flood, drought and intense
storms stemming from climate change.
Now is the time for a focused study on the complex, interdependent and powerful
impact of natural systems change on our human health, say prominent scientists such
as Richard Horton. Ignoring or failing to address these changes, Horton, The Lancet
editor-in-chief argues, threatens our social fabric, systems, structures and civilization.
As evidence mounts and attention shifts to this urgent area, a number of ideas are
emerging. Many of these surfaced at a July 2014 “Future of Planetary Health“ meeting,
hosted by The Rockefeller Foundation. They range from harnessing data, analytics and
predictive modeling to build the business case for different policy and natural resource
The progress we’ve
made in global health
is only sustainable
if we also consider
the health of the
planetary systems on
which human health
depends.
Judith Rodin, president,
The Rockefeller
Foundation

5. 5Planetary Health
use decisions; to storytelling to inform and incite action; to bringing new players, such
as millennials and local communities into the fold to lead behavioral change.
Five of these are believed to be particularly applicable to help solve some of the
critical, enmeshed challenges. They are outlined below. These ‘future solutions’, or
key recommendations, emerged from discussion among five working groups that
focused on the human health impacts of changes in our planet’s climate, biodiversity,
land-use and in its marine and freshwater ecosystems:
1. Better governance structures for managing global resources: Coveted global
“commons” such as freshwater, air, forests and oceans have not been sufficiently
protected, because market economies often fail to fairly value healthy commons, or
to extract costs for damaging them. To help protect the ocean commons and reduce
overfishing, the Oceans Working Group proposed an oceans-focused United Nations
agency. To provide a viable commercial alternative to the current fishing industry, the
group recommended establishing and scaling up a sustainable aquaculture industry
by 2030. Other suggested goals included developing a global fisheries lab to measure
and monitor the health of wild fisheries through, for example, innovative technologies
such as deep-sea robots monitoring progress in rebuilding fish stocks.
2. Evidence-based input about the likely impact of land-use changes to influence
decision-making: Those who make land-use decisions often fail to grasp the positive
and negative impacts of their decisions on the health of often distant ”downstream”
communities, particularly in areas with robust agro-industrial development around
rapidly growing cities. To better inform natural resources management and public
health decisions, the Land Use Working Group proposed case studies to explore the
human health impact of ecosystem changes on such areas as infectious diseases,
nutrition and mental health. Such studies may demonstrate how alternative approaches
that explicitly account for the public health consequences of environmental change
can increase system sustainability and resilience. To provide city leaders with real-
time, relevant information for key decisions, the group also recommended generating
relevant health and environmental data through personal and site-based monitoring.
Such quantifiable measures might trigger a range of market-based solutions, such as
payments for ecosystems services or tax incentives.
3. More evidence-based information about the potential benefits of ecosystems
protection to spur policy change: Policy makers will be more apt to craft laws and
incentives and fund programs that protect vital ecosystems with quantitative measures
of their benefits. The Biodiversity Working Group proposed the increased use of national
”natural capital” accounts, forecasting models and environmental-impact statements
to help measure the long-term human health impacts of environmental change to
motivate businesses, communities and government to change their behavior.
4. New business models to deliver scarce resources to underserved and
vulnerable regions: Vital goods and services like water often fail to reach the poor in
small and remote villages because infrastructure costs are prohibitively high. But many
innovative financing and delivery schemes have emerged that make this possible and
protect the environment. Such models—including microfinancing, crowdsourced
Are we able to act
quickly enough to
reverse our course?
Montira Pongsiri,
environmental
scientist, US
Environmental
Protection Agency1
1
In her personal capacity

6. 6 Planetary Health
funds and payment-for-ecosystem-services programs—were the cornerstone of the
Freshwater Working Group’s proposal to help bring clean water to the world’s 1 billion
people with insufficient to no water supply. Suggested building blocks include web-
based proposal templates for communities to begin fund-raising efforts, and a global
Water Corps to advise communities on building and maintaining water infrastructure.
Small-scale water-collecting solutions like cisterns, open data for stakeholders to track
water distribution and conservation progress, and alternative payment currencies
such as “water coin” (like Bitcoin) were among other recommendations.
5. The creation of an entirely new field to focus attention, resources and action
on this urgent area: At watershed moments in history, new institutions and ways
of thinking have surfaced for a singular focus on critical issues. The Climate Change
Working Group called for an entirely new discipline to tackle accelerating and complex
problems linked to the environmental change–human health nexus in a rapid and
EXECUTIVESUMMARY
We need more
minds like
those who built
cathedrals. They
will never see the
light of day until it
is finished. But they
continue to work.
Derek Yach,
senior vice president,
Vitality Group

7. 7Planetary Health
calibrated way. It recommended communications campaigns and convening investors
and funders within a year to finance and focus on the programmatic aspects of this
new field. The commission and future work will explore this undertaking.
As we pass critical environmental thresholds, the threats are great to both human
health and survival. We can intervene and shift bit by bit the trajectory of environmental
change and these threats. We can collaborate across many sectors that are directly
impacted by these changes, such as environmental science, food production,
construction and public health.
But without a distinct focus by public-health practitioners on the accelerating, complex
and profoundly interdependent drivers of ecological change and human health, our
very civilization is at risk. Only then will all the critical players in the private sector,
government and science fall into place, to advance research, policies and action at
global, regional and local levels.
We must be
disruptive and
revolutionary.
Change cannot be
incremental
Fred Boltz, managing
director of Ecosystems,
The Rockefeller
Foundation

8. 8 Planetary Health
Human health and the environment have been interwoven since the beginning of time.
Temperate conditions helped societies thrive in lush coastal regions like Mesopotamia,
the Mediterranean and the Mississippi Delta over five millennia. Rainfall quantity and
soil quality in an agrarian world first determined health and wealth and drove the
development of a merchant economy, as cotton, fish and timber were bought, sold
and traded. As a result, some societies prospered and others floundered. These
forces ebbed and flowed, largely with the earth’s natural order.
The coal furnaces and factories of the Industrial Revolution changed all that. A surge
in production brought prosperity to many. But the belching smokestacks of the 1800s
rained toxins on many homes and farms and triggered lung infections; progress in
the use of chemicals and fertilizers improved lives, but also often brought unintended
health consequences, such as other diseases. Medicine made great gains over
that time, as public-health systems and resources to fund them triggered medical
innovation, treatment and cures. But scientists struggled to keep pace with the spate
of new illnesses.
Still, in no other era has the natural rhythm of our planet’s weather, air and land-
use patterns changed so dramatically as in our own, largely due to humanity’s very
visible hand. While the world is much wealthier than it was a century ago, the wealth
accumulation has come at a price to our planet’s lungs and our own. Paradoxically,
while illness triggered by discrete environmental impacts such as pollution has
decreased with improvements in medicine, water and food safety, the vulnerability of
our health increases due to unpredictable climate change patterns. Rising affluence
and rapid population growth are likely to accelerate the pace of environmental change
and threats to human health.
Scientists and policy makers are sounding the alarm. They are calling for deeper
and broader research into the interdependent and complex nature of the relationship
between our environment and our health so that governments, organizations and
companies can respond more effectively. They are also calling for institutional change
to address threats to our enmeshed environmental, human health and social and
economic systems as we cross critical thresholds. By devising the right strategies and
spotting opportunities to shift the trajectory, experts hope to improve our stewardship
of the planet and safeguard human health.
Improving human health by healing the planet
Planetary health
Why did the
Mesopotamian and
Roman civilizations
collapse? What
was the role of
environmental
factors?
Richard Horton,
editor-in-chief,
The Lancet

9. 9Planetary Health
Climate change is
seen as a remote
threat in space and
time.
Howard Frumkin,
dean, School of
Public Health,
University of
Washington
To imagine a different future by 2025 and surface strategies that may help us get there, in
July 2014 British medical journal The Lancet and The Rockefeller Foundation convened a
high-level, four-day conversation with experts for an honest assessment of the health of
the earth and of humanity—and the connections between the two. The meeting aimed to
identify gaps in our knowledge and to build an accelerated, global and multi-sectoral plan
to advance research and spur action.
It also sought to inform international policy and incite proactive responses before
we cross critical environmental thresholds. With the world population set to soar to
9.6 billion by 2050—and with more than half of all people already living in cities—
addressing this problem is all the more urgent.
Global leaders at the meeting hailed from over 30 institutions, organizations and
companies, including Harvard Medical School, the United Nations, the African
Development Bank, the X-Prize Foundation, PepsiCo and Monsanto (see list of
participants in the appendix).
“The world is undergoing enormous stress. Many parts of the world are suffering
from the human footprint, which is testing the biosphere’s capacity,” said Richard
Horton, editor-in-chief of The Lancet, at the meeting’s opening. “If we transcend
critical environmental boundaries, we get into deep trouble. Meanwhile, we struggle
with partisan gridlock, stressed financial institutions and fractured nation-states. As
we move forward, I have a feeling of immense danger,” he said. “How do we present
the science to motivate behavioral change?”
The conversation

10. 10 Planetary Health
A useful starting point for understanding the environmental and human health
nexus is “planetary boundaries,” or tipping points in our planet’s air, land, fresh
water and ocean natural systems that are most influenced by environmental shifts.
These boundaries were defined in 2009 by a group of 28 internationally renowned
scientists (http://www.stockholmresilience.org/21/research/research-programmes/
planetary-boundaries/planetary-boundaries/about-the-research/the-nine-planetary-
boundaries.html). The framework considers changes in our natural systems, including
ozone levels, biodiversity loss, atmospheric greenhouse gases, ocean acidification,
land use change (see chart, pp. 11), and other environmental changes that threaten
the conditions under which humanity can “safely operate.”
If one or more of these boundaries is breached, altered environmental trajectories
could cause rapid, nonlinear and irreversible changes in planetary systems that
could jeopardize the very survival of the human species. Notably, three planetary
boundaries have already been crossed—those of climate change, biodiversity and
the global nitrogen cycle—according to the framework’s architects. Atmospheric CO2
has increased by 40% since 1800, primarily from burning fossil fuels and land-use
changes that have resulted in increased polar-sheet ice melting, a sea-level rise of
0.19 meters since 1900 and ocean acidification.
Planetary Boundaries

11. 11Planetary Health
1. STRATOSPHERIC OZONE LAYER
This layer of the atmosphere filters out
ultraviolet radiation (UV) from the sun.
Its thinning allows more UV to reach the
ground, which can increase the incidence
of skin cancer. Though the Antarctic ozone
hole suggested a bypassed threshold,
Montreal Protocol actions have reversed
this trend.
2. BIODIVERSITY
Changes in biodiversity due to human
activities were more rapid in the past
50 years than at any time in human
history according to the 2005 Millennium
Ecosystem Assessment. High rates of
extinction and ecosystem damage can be
slowed by efforts to preserve threatened
species, critical habitats and connectivity.
Further research is underway to determine
whether a boundary based on extinction
rates is sufficient.
3. CHEMICALS DISPERSION
Toxic compound emissions from heavy
metals, synthetic organic pollutants and
radioactive materials can persist in the
environment for a very long time, and their
effects are potentially irreversible. Chemical
pollution can result in reduced fertility and
potentially permanent genetic damage
within ecosystems. Persistent organic
compounds, for example, have reduced
bird populations dramatically and impaired
reproduction and development in marine
mammals.
4. CLIMATE CHANGE
The Earth has already transgressed the
planetary boundary and is approaching
several Earth system thresholds. Climate
change is driving the Earth system into
a much warmer state with intensified
climate impacts. These include summer
polar sea-ice loss which is seemingly
irreversible and sea levels metres higher.
Weakened or reversed terrestrial carbon
sinks due to ongoing deforestation and
agricultural emissions is another potential
tipping point. How long remains before
large, irreversible changes become
unavoidable is an open question.
5. OCEAN ACIDIFICATION
Greater ocean acidity, currently more than
30% over pre-industrial levels, reduces
the amount of available carbonate ions,
an essential ‘building block’ used by many
marine species for shell and skeleton
formation. Rising acidity threatens the
growth and survival of organisms such as
corals and some shellfish and plankton
species, which would change the structure
and dynamics of ocean ecosystems
globally. The boundaries are tightly
interconnected since atmospheric CO2
concentration is the controlling variable for
both the climate and the ocean acidification
boundaries.
6. FRESHWATER CONSUMPTION AND
THE GLOBAL HYDROLOGICAL CYCLE
Human pressure now largely determines
the function and distribution of global
freshwater systems. Consequences include
global-scale river flow changes and vapour
flow shifts arising from land use change.
Shifts in hydrology may be abrupt and
irreversible. Because water is increasingly
scarce—by 2050 about half a billion people
may be water-stressed—a boundary
related to consumptive freshwater use and
water resilience is a vital index for human
development.
7. LAND SYSTEM CHANGE
Forests, wetlands and other vegetation
types have primarily been converted
to agricultural land, seriously reducing
biodiversity, and impacting water flows
and the biogeochemical cycling of carbon,
nitrogen and phosphorus and other
important elements. Collectively, these local
land cover changes have consequences for
Earth system processes on a global scale.
8. NITROGEN AND PHOSPHORUS
INPUTS TO THE BIOSPHERE AND
OCEANS
The biogeochemical cycles of nitrogen and
phosphorus have been radically changed by
humans as a result of many industrial and
agricultural processes. Fertilizer production
and application results in dramatic increases
of emissions not absorbed by plants. When
in rain, these pollute waterways and coastal
zones or accumulate in the terrestrial
biosphere. Large amounts of applied
nitrogen and phosphorus end up at sea
and can push marine and aquatic systems
across ecological thresholds.
9. ATMOSPHERIC AEROSOL LOADING
Through their interaction with water vapour,
aerosols play a critically important role in the
hydrological cycle affecting cloud formation
and global-scale and regional patterns of
atmospheric circulation, such as monsoons
in tropical regions. They also change
how much solar radiation is reflected or
absorbed in the atmosphere. Humans
change the aerosol loading by emitting
atmospheric pollution and also through
land-use change that increases the release
of dust and smoke into the air. Inhaling
highly polluted air causes roughly 800,000
people to die prematurely each year.
The nine planetary boundaries
Source: Stockholm Resilience Centre; www.stockholmreslience.org/Rockefeller Foundation

12. 12 Planetary Health

13. 13Planetary Health

14. 14 Planetary Health
Scientists are now studying the links between global environmental changes affecting
the earth’s essential support systems and human health. These primary health impacts
were explored in a background paper presented at the meeting by The Lancet. The
paper examines possible strategy and policy shifts to prevent or reduce the damage,
and proposes interdisciplinary and collaborative research to better inform decisions.
The potential range and extent of impacts on human health are startling and beg
for action. For instance, fisheries, a key global food source, are already collapsing
in many parts of the world due to overfishing. The interplay of this alarming trend
with rising acidity in our oceans threatens serious further damage. (Ocean acidity has
increased by around 30% since the Industrial Revolution due to the absorption of
carbon dioxide, and could double again by 2050.)
Climate change alone will potentially trigger a rise in under-nutrition, heat-related
deaths, some vector-, food- and water-borne diseases, and floods, drought and intense
storms, according to the United Nations’ Intergovernmental Panel on Climate Change
(IPCC). In 2006, the World Health Organization (WHO) estimated that environmental
factors contribute to nearly a quarter of all human diseases, from established risks
like air pollution, insufficient or tainted water supplies, and poor sanitation. But that
number is probably much higher when accounting for the environmental-change-
related risks we are only now beginning to understand.
Of the nine planetary boundaries, the interplay of four—climate change, biodiversity
loss, land use and freshwater consumption—creates perhaps the most immediate
challenge to both planetary and human health. Our land-uses have a particularly
heavy ”ecological footprint.” Forest clearing for farming, timber or land development
can erode biodiversity, fragment and pollute watersheds, rob the soil of key nutrients,
and reduce the natural infrastructure that serves as buffers against extreme weather
events and human vulnerability.
The immediate and alarming health impacts of these changes are many and varied.
They include the rising prevalence and faster spread of disease from insect and
mammal carriers, such as Lyme disease, West Nile virus, bird flu and hemorrhagic
viruses including Ebola. Many waterborne diseases, from cholera to typhoid fever to
shistosomiasis, are transmitted through human exposure to polluted waters and to
natural parasites. Natural ecosystems regulate disease incidence and transmission. It
is particularly challenging to confront the rising incidence of, and human exposure to,
these diseases as the ecosystems harboring the causes of disease, their carriers and
their natural predators are damaged or disappear.
Areas of risk
Our success with
the easier health
problems may
bring some cause
for optimism. But
the next set of
challenges due to
rapidly changing
environmental
conditions is far
more complex,
with multiple
interactions. These
threaten all our
gains in health.
Samuel Myers,
research scientist,
Harvard School of
Public Health

15. 15Planetary Health

16. 16 Planetary Health
Diseases are also appearing in abnormal locales as weather patterns shift. Malaria
and Dengue fever have surfaced in Europe, and the West Nile virus on the U.S. East
Coast. As higher latitudes and altitudes become warmer and wetter, they become
more suitable environments for “tropical” diseases and their animal and insect
carriers. These diseases can spread quickly and rapidly become epidemics as air
travel and contact with those across the world rise. The world is ill-prepared for the
migration of diseases to new places, driven by climate change, continued ecosystems
degradation, and the rising exposure of people to such diseases.
The links between biodiversity loss and human disease transmission are thoughtfully
explored in “Biodiversity Loss Affects Global Disease Ecology,” by Montira J. Pongsiri
and others in the December 2009 issue of Bioscience, also distributed prior to the
meeting (http://www.epa.gov/ncer/biodiversity/pubs/bio_2009_59_11.pdf).
Respiratory diseases like asthma are rising along with CO2
emissions, too. In fact, air
pollution is now the world’s single largest environmental health risk. Approximately
7 million people died in 2012 as a result of air pollution (one in eight of total global
deaths), according to WHO, double the organization’s earlier annual estimates. The
deaths are the result of fine particles in our atmosphere that come from burning coal
or diesel fuel, industrial emissions, and from indoor, household sources, such as
inefficient cook stoves or burning wood, dung or coal, particularly in poor countries.
Many of these air pollutants also contribute to climate change.
Human health will increasingly suffer in the future as a result of the environmental
changes that are affecting the basic human needs of water and food. In some
regions, less water is likely to be available for human use, for sanitation, hygiene
and food production due to changes in temperature, rainfall and pollution, and water
overuse. Pollinators like bees that help trigger and increase food production may
also disappear when their natural habitats vanish. Lastly, the nutritional quality of
the food we eat may fall with a rise in atmospheric CO2
levels. For example, in some
crops, micronutrients such as zinc and iron fall with a rise in atmospheric CO2
levels.1
Without decisive action, global average temperatures could rise four degrees above
pre-industrial levels by the end of the century, posing serious threats to our well-
being and to global economic development, according to the IPCC.
1
Myers, Samuel S., et al. “Increasing CO2 threatens human nutrition.” Nature510.7503 (2014): 139-142.
http://www.nature.com/nature/journal/v510/n7503/abs/nature13179.html

17. 17Planetary Health
A recent and comprehensive overview of the complex impacts of environmental
change beyond biodiversity loss and climate change is “Human Health Impacts of
Ecosystem Alteration” (http://www.visionariesunbound.com/static/pdf/PNAS%20
2013%20Human%20health%20impacts%20of%20ecosystem%20alteration.pdf),
by Samuel Myers of the Harvard School of Public Health and others, published in
the November 2013 issue of Proceedings in the National Academy of Sciences, and
distributed prior to the meeting. It explores current findings in this emerging field and
suggests filling gaps in our knowledge that could advance both policy and decision-
making among land-use planners, conservationists and public-health practitioners.
The authors point to unprecedented change in the earth’s natural systems evidenced
by the transformation of nearly half the world’s ice-free landmass into cropland, the
felling of half our temperate and tropical forests, and the construction of 800,000
dams, which today affects the flow of 60% of the world’s rivers.
Among the human-health impacts of these land-use changes are the loss of nutrients
from wild foods and fish; the cardiorespiratory impacts of reduced air quality; and
food insecurity and population displacement.
Still, the research into environment-health linkages remains patchy, the paper’s
authors say, because it has often focused on a specific disease, rather than the
impact of environmental change on several aspects of human health, and often on
just one possible trigger, though there may be several. Some of these triggers may
foster negative health effects in some communities but bring health benefits to others.
Malaria exposure, for example, may rise from the interplay of deforestation, altered
biodiversity and human migratory patterns, and dam and irrigation projects. But that
same dam or irrigation project could improve access to clean electricity and water
for irrigation and for food production for other or future populations. The authors also
contend that both poor communities and future generations face disproportionate
consequences because the breadth and pace of the erosion of natural systems is
expanding with population growth and increasing prosperity.
They suggest broadening research efforts beyond snapshots of one disease in a
particular place to comparisons of environmental links across locations. They also
advocate expanded research into highly prevalent infectious diseases that have
clear links to environmental change, such as malaria, diarrhea, Dengue and Chagas
disease. And they encourage studies of the links between natural-system changes
and nutrition and food productivity, and the health value of ecosystem services.
Among the areas the authors believe particularly merit further research, including field
experiments and modeling, are animal husbandry; land-use changes and zoonotic
Recent Research
We need new
institutions and
incentives, and
tools to for
intersectoral
collaborations and
asset mapping.
Sania Nishtar,
founder and
president, Heartfile

19. 19Planetary Health
diseases; and health outcomes driven by multiple changes, such as resource scarcity,
land-use changes and climate change.
The tight link between the biosphere and our health is becoming ever more apparent.
But this connection remains poorly understood and largely invisible to the public. The
result is little action to safeguard our planet and our well-being.
“Let’s connect the dots between health and the environment and appreciate the
interdisciplinary nature of these fields. What are the pressure points? What are the
areas of dynamism? Think fifteen years out and develop a road map and strategies
for change,” urged Vijay Vaitheeswaran, The Economist’s China business and finance
editor, who facilitated the meeting. “There is tremendous opportunity to strengthen
links and shape organizational change.”
RECENTRESEARCH

20. 20 Planetary Health
There is no time to waste in developing road maps and strategies for change. Even
as we work to improve our understanding of the size, scope and complexity of the
environmental changes we are experiencing and their impact on humanity, we must
mobilize several forces to take action.
An expansive range of sound strategies are emerging to tackle these complex and
interlinked problems, many of which were discussed in Bellagio. They include:
1. Use evidence-based science to drive policy change. Scientists and
policy makers speak different languages, operate in different time frames and
respond to different incentives. Broadly speaking, policy makers represent their
constituencies and build coalitions for broader action that provide a basis for
change, while managing political risk. Simple language and clearly articulated,
quantifiable “high-impact” proof matters most to decision makers. For instance,
information on the immediate impact of environmental changes on the health
of their constituencies could help convince policy makers to develop new laws,
incentives and resources to address these linkages. “This is very different from
building the body of objective evidence [that scientists seek],” said Anthony
Kaplan, director of Global Health at United Nations University.
2. Harness data, analytics, predictive modeling and other innovative
tools to build the business case for change and to reduce the impact of natural-
resource extraction and use through more-efficient, holistic approaches that
involve local communities. Collecting vast data from satellites and handheld
devices, examining them with analytical tools, and modeling how different choices
can alter environmental outcomes can help inspire powerful behavioral change
among businesses and individuals. Quantifying the impacts and possible savings
that could be realized by incentive-based initiatives, such as programs that pay
individuals to protect the environment (for example, to prevent cattle grazing near
rivers or streams), could help scientists and government leaders win the support
of companies and the public – and inspire them to act.
“We need to bring financiers, economists, accountants, scientists and engineers
together to create open-source tools to join up everyone on real practical outcomes
for human and ecological health,” said Professor Peter Head, an engineer and
executive chairman of the Ecological Sequestration Trust. “This is the moment. We
have earth observations, adequate data computing power, systems algorithms
and communications bandwidth to use it all from the cloud.”
Strategies
It’s not a scientific,
intellectual
discussion. How
do we get people
engaged?
Anne Fudge,
Trustee, Rockefeller
Foundation

21. 21Planetary Health
3. Raise awareness and galvanize action on the full breadth of climate
risks. Hurricane Sandy and Typhoon Haiyan focused attention on the link between
climate change and extreme weather events. Such storms have severe implications
for health, life and property loss, if they cause a breakdown of water-supply
systems vital to sanitation and irrigation, enable the spread of disease, or slow the
delivery of critical supplies to health clinics and hospitals. But scientists, activists
and others must also find ways to raise awareness of the slower-moving and less
dramatic – but possibly even more alarming – impacts of climate change, such as
the loss of ”buffers” to shore up coastlines against storm surges, vanishing reefs
due to ocean acidification, and the spread of disease to new regions. Only under
the glare of the spotlight can we raise awareness and inspire behavior change.
4. Cross-pollinate ideas across sectors through collaboration, coalitions
and change agents. Business executives respond to profits and shareholder
pressure, scientists to breakthrough research and peer recognition, government
officials to a smoothly functioning society and satisfied constituencies, individuals
to their wellbeing and happiness. Each group has a role to play in raising
awareness and sharing ideas about effective ways to solve the environmental/
human-health change nexus problem. These areas of self-interest need to be
explored, incentives aligned and concrete actions assigned to each party, if
we are to have rapid, coordinated and systems-based responses. Challenges
include winning buy-in from large, complex institutions and overcoming ”pride of
ownership” issues. Particular efforts should be made to level individual silos and
to agree on a common language.
5. Storytelling to inform, incite action and change behavior. Campaigns that
speak to the heart rather than the head are more likely to inspire broad individual
and collective change in how we live, what we buy and eat, and how we move.
“Naming and shaming” can help keep a check on businesses and individuals. But
illustrating a new vision of prosperity, such as the Joint US-China Collaboration
on Clean Energy (JUCCCE) campaign ”China Dream,” may more effectively alter
people’s outlooks and lifestyles now and in the future. Sharing personal stories
about the impact of our consumption habits on the health of our planet and that
of our community may spark change. The media, marketers and advertisers must
be engaged in telling stories about people and places that offer meaning and
messages that will move people. “People’s thinking is guided by set patterns and
beliefs. While we need the science, science has precious little to do with how
people reach conclusions,” said Howard Frumkin, dean of the School of Public
Health at the University of Washington. “We need to understand much better how
to change behavior.”
6. Harness generational power to push for change. Millennials are viscerally
aware of the environmental harm that human activities are reaping on the planet
in an era that is better informed about the planet’s declining capacity to sustain
the human species. This cohort has also shown a willingness to act; many
demonstrate personal dissatisfaction through protests and with their wallets
through green purchases. The collective power of young people can be further
harnessed by identifying and enlisting youth leaders, targeting Millennials with
information campaigns, and collaborating with the social enterprises they have
STRATEGIES

22. 22 Planetary Health
founded. “Whose earth are we talking about? There’s a mismatch between those
who pollute and those who suffer the consequences,” said Dr. Frumkin.
7. Bring new players into the fold and identify leaders to accelerate action.
Engaging and connecting groups like businesses, financiers and local communities
can broaden awareness and trigger quick, calibrated action. We need to find new
approaches for natural resource use that are more sustainable and environmentally
friendly, to finance these measures in creative ways, and to inspire local communities
to demand market-based change through their purchases, activities and protests.
To do so we must identify champions and change agents in these groups and
work with them to harness their power. “This is about corporate survival and
death. It’s not about CSR,” said Derek Yach, founder of the Vitality Group, referring
to corporate social responsibility. “PepsiCo was given a license to operate in
perpetuity. They have to be long-term stewards of the earth. It’s absolutely material
to the bottom line of companies, not because it’s a nice thing to do.”
8. Tear down old structures, such as institutions, incentives and disciplines,
to advance work in this area. Deeply rooted incentives and approaches
to research at universities and research centers often dissuade scientists from
working with outsiders to accelerate the real-world applications of their work. The
tenure process, the slow pace of academic publishing, empire building, and the
tenacity with which researchers pursue research are among the obstacles that too
often get in the way of progress. Public health needs to become less prescriptive
and more proactive. “Like a dog with a bone, people don’t like to give up on their
ideas,” said The Economist’s Vaitheeswaran.
9.Createnewstructuresandinitiativestogalvanizeaction.Theunprecedented
environmental changes occurring on our planet and the widespread and potentially
catastrophic consequences of changes yet to come demand a radical rethink of
how to confront and tackle the challenges we all face. Incremental change will not
suffice. New institutions, leaders and approaches are required to heal our planet
and safeguard human health. “Unless there is a global mindshift in thinking this
will be at the margins,” said Michael Meyers, managing director at The Rockefeller
Foundation.
You’re a lot more
effective when you
engage the crowd.
Paul Bunje,
XPRIZE Foundation

23. 23 Planetary Health

24. 24 Planetary Health
A handful of promising solutions are taking shape that address specific problems at
the nexus between human health and environmental change and do so in ways that
address the knotty and interlinked forces at work. Working groups focusing on the
human health impacts of changes in our planet’s climate, biodiversity, land-use and
in its marine and freshwater ecosystems in Bellagio identified a number of emerging
solutions for future problems that particularly merit exploration, including:
1. Better governance structures for managing global
resources:
Coveted global “commons,” such as air, forests and oceans, have not been
sufficiently protected. A key reason for this is the failure of market economies to
adequately value healthy commons or to extract costs for damaging them. For
example, oceans cover 70% of the earth’s surface, absorb half the world’s ever-
rising levels of CO2
, supply fish that nourish some 2.5 billion people, and employ
millions in the $200 billion fishing industry. Yet the two-thirds of the oceans that
lie outside natural boundaries are currently unregulated, with fish stocks at or
beyond their ability to replenish themselves. A predicted doubling in demand for
fish by 2050 is particularly worrisome. The commercial importance of oceans
is also rising as sea ice melts, clearing the way for new seafaring routes, oil
drilling and mineral extraction and the specter of growing territorial disputes.
There are far-reaching implications for the human populations who depend on
fish for nutrition and livelihoods.
To help protect the ocean commons—and, specifically, to rapidly reduce
overfishing—the Oceans Working Group explored a range of possible solutions.
It recommended establishing a new oceans-focused United Nations agency to
regulate this shared resource and territory, and to forge guidelines to ensure
the health of the oceans. To provide a viable commercial alternative to the
current fishing industry, it recommended establishing and scaling a sustainable
aquaculture industry by 2030 to meet rising human demand and reduce the
overfishing of wild populations. Other recommendations included developing
a global fisheries lab to monitor and track the health of wild fisheries, and to
quantify the link to the physical and economic health of the communities that
depend on them.
Change might come from the use of innovative technologies, such as deep-
sea robots that monitor our progress in rebuilding fish stocks; and creative
Future solutions
We need to stop
talking to people’s
heads, but to their
hearts. We need to
use emotion.
Peggy Liu, founder,
Joint US-China
Collaboration on
Clean Energy

25. 25Planetary Health
campaigns that have broad appeal, such as “Saving Dora,” built around the star
of the upcoming sequel to ”Finding Nemo.”
“It’s unrealistic to dismantle a massive industry without presenting a viable
commercial alternative,” said Freya Williams, group head of Business + Social
Purpose at Edelman. “In our optimistic narrative, we’re focusing on abundance
and opportunity.”
2. Evidence-based input about the likely impact of land-use
changes to influence decision-making:
Those who make land-use decisions often fail to grasp the potential far-reaching
impacts of their decisions on human health. These choices can cause significant
harm—or bring benefits—to the health of often distant “downstream” communities,
or to those in rapidly growing urban areas, as land near cities is developed for
industrial or agricultural use.
To better inform natural-resources management and public health policy and
decisions, the Land Use Working Group proposed a range of solutions. These
include case studies to document the human health impacts of changes to
environments within cities and of alterations of ecosystems in more remote,
pristine areas. Case studies would focus on environmental changes believed to
disproportionately influence human health in such areas as respiratory, waterborne
and infectious disease, and in nutrition and mental health. This type of explicit
analysis of the public health impacts of environmental change would emphasize
co-benefits for human health, sustainability and system resilience.
The group also recommended a “climate-friendly cities portfolio” to generate
relevant health and environmental data through personal and site-based
monitoring, to provide city leaders with real-time, relevant information as they
make key decisions.
These approaches would provide quantifiable measures of health impacts, which
would facilitate a range of market-based solutions such as payments for ecosystems
services or tax incentives to solve pressing problems at the environmental change–
human health nexus.
3. More evidence-based information about the potential
benefits of ecosystems protection to spur policy change:
Decision makers are often unaware of the benefits that healthy ecosystems bring
to human health, of the complex interactions among their components (including
people), and of the negative consequences of environmental change on natural
systems.
As participants in the Biodiversity Working Group noted, policy makers will be
more apt to craft policies and incentives and fund programs that protect vital
ecosystems with quantitative measures of their benefits. One approach is through
the use of national “natural capital” accounts – or logs of the values of each
FUTURESOLUTIONS

26. 26 Planetary Health
Don’t give up on
anything; we need
to pursue parallel
paths.
Anne Fudge,
Trustee, Rockefeller
Foundation
country’s ecosystems’ resources and servicing capabilities, and changes to their
condition over time. Such tools—as well as forecasting models and integrated
health-environmental impact statements that help measure the long-term human
health impacts of environmental change—might motivate businesses, communities
and governments to change their behavior.
Quantifying the long-term human health consequences of environmental change
and clearly communicating findings to authoritative organizations like WHO and
the World Bank could also inform global and country guidance and technical
assistance. The group urged the United Nations to recognize the biodiversity–
human health link in the UN’s Sustainability Development Goals, which is a set of
global guidelines being established to help ensure that sufficient natural resources
are available for the prosperity and health of future generations.
4. New business models to deliver scarce resources to
underserved and vulnerable regions:
Vital goods and services like electricity and water often fail to reach the poor in small
and remote villages because infrastructure and delivery costs may be prohibitively
high. Other barriers include ineffective but entrenched methods of supplying these
goods and services, due to vested business or government interests and a lack
of awareness within local communities that there are affordable and decentralized
alternatives for such services. At the same time, local communities are rarely
motivated to protect the natural resources they depend on for food, sanitation and
other services. But in recent years, a number of innovative financing, delivery and
incentive models have emerged that can make the supply of these vital goods and
services more efficient and scalable—while protecting the environment.
Such models include microfinancing, crowdsourced funds, and outsourced
and payment-for-ecosystem-services programs. These approaches were the
cornerstone of the Freshwater Working Group’s proposal to help bring clean water
to the world’s over 1 billion who lack access to safe drinking water. As building
blocks, the group suggested raising funds through initiatives like the Whole World
Water campaign; providing web-based proposal templates to communities to begin
fund-raising efforts; and a global Water Corps to advise communities on building
and maintaining new infrastructure. It also proposed small-scale water-collecting
solutions like cisterns; conservation measures such as watershed protection to
help make communities environmental stewards, and monitoring and fixing leaky
pipes to maximize the supply available.
Finally, the group suggested opening up access to data sources on the web so
that stakeholders can track water distribution and progress on conservation for
the benefit of both the community and funders; enabling payment with alternative
currencies like “water coin,” (a proposed currency similar to bitcoin); and the
establishment of pilot cities to test project elements needed in arid, coastal and
temperate environments, so that several formats can be created that apply to
similar locales. “There are a lot of ways to scale once you get past the limiting
factors,” said Peggy Liu, founder of JUCCCE.
FUTURESOLUTIONS

27. 27Planetary Health
5. The creation of an entirely new field to focus attention,
resources and action on this urgent area:
At watershed moments in global history, new institutions and ways of thinking
have surfaced for a singular focus on critical issues. Such was the case with the
Marshall Plan, the United Nations Earth Summit and U.S. civil rights legislation.
Indeed, as the existential nature of the threat of environmental change on our
health, our social and political systems, and our society becomes more apparent,
a global reframing and rethinking of the tangle of issues is required. This was
the determination of the Climate Change Working Group. It called for entirely
new institutions and approaches to tackle accelerating problems in a rapid and
calibrated way. Scholars and business and government leaders must come
together to develop a road map to address planetary health, and to roll it out.
Only when many disciplines converge in a holistic manner to build and shape
new institutions will true and rapid progress be possible, the group argued. This
requires the concerted creation of a new field of study and practice: an integrated
and institutionalized field of planetary health.
“Our entire conversation about how we communicate the challenges and engage
our institutions is rational and linear,” said Paul Bunje of the XPRIZE Foundation.
“But these challenges are complex and exponential. We should communicate
in the same way. We need an army of thinkers, doers and communicators to
establish a holistic field of Planetary Health.”
To get there, we will need communications campaigns. To achieve a goal of creating
a professional class exclusively focused on this field with established leaders by
2020, we will need to convene in the next year funders, investors and insurers to
finance and focus on the programmatic aspects of this new field. Global centers
of excellence could be valuable, too. With concerted effort, “by 2020 this will all
exist,” predicted Bunje. “We will be unstoppable.”
FUTURESOLUTIONS

28. 28 Planetary Health

29. 29Planetary Health
As we look ahead to a world in which our health will suffer from stretched resources
and stressed systems, the environmental harm we have wrought weighs heavily. To
be sure, governments and businesses that rely on nature for food production, raw
materials, energy and freshwater are increasingly aware of the impact of our activities
on the planet. But the world has yet to grasp the complex and far-reaching human
health consequences of our choices.
Yet our civilization continues to evolve, to innovate, to achieve scientific breakthroughs,
and to find novel solutions that could yet be our salvation. As experts underscored at
the Planetary Health meeting and beyond, solving these problems requires deep and
broad collaboration across many sectors, dramatic institutional and system change,
and moving storytelling that can inspire behavioral change.
Many of the strategies and solutions the experts have identified can be put into ac-
tion in a piecemeal fashion. But truly understanding and addressing the problem of
ecological change and its health impact requires a more radical approach, new ways
of thinking and an entirely new discipline dedicated to exploring solutions and imple-
menting widespread change. We at The Rockefeller Foundation stand ready to help
drive this process forward. We hope you will join us on this journey.
Conclusion

30. 30 Planetary Health
Bottom, left to right: Steven Osofsky, Montira Pongsiri, Carolyn Whelan, Judith Rodin, Robert Garris, Gabriela
Burian, Peggy Liu, Paul Bunje, Fred Boltz and Selina Lo
Middle: Ann Fudge, Tara Acharya, Samantha Silberberg, Fernanda Bak, Elizabeth Williams, Howard Frumkin,
Derek Yach, Sarah Whitmee, Srinath Reddy Kolli, Agnes Soucat, and Natasha Loder
Top: Michael Myers, Wai Chiong Loke, Peter Head, Richard Horton, Braulio Ferreira de Souza Dias, Samuel
Myers, Subhrendu Pattanayak, Anthony Capon, Sania Nishtar and Vijay Vaitheeswaran
Planetary health
Meeting Participants

31. 31Planetary Health
1. Tara Acharya
Senior Director, Nutrition
PepsiCo
2. Chris Beyrer
Professor, Epidemiology
Johns Hopkins University
3. Fred Boltz
Managing Director, Ecosystems
Rockefeller Foundation
4. Paul Bunje
Senior Director, Oceans
XPRIZE Foundation
5. Gabriela Burian
Environment Lead
Monsanto – Sustainability
6. Anthony Capon
Director
United Nations University
7. Braulio Ferreira de Souza Dias
Executive Secretary
Convention on Biological Diversity
8. Alex Ezeh
Executive Director
African Population and Health Research
Center
9. Howard Frumkin
Dean and Professor, University of Washington
Environmental & Occupational Health
10. Ann Fudge
Trustee
The Rockefeller Foundation
11. Robert Garris
Managing Director
The Rockefeller Foundation
12. Andy Haines
Professor of Public Health and Primary Care
London School of Hygiene and Tropical
Medicine
13. Peter Head
Executive Chairman
The Ecological Sequestration Trust
14. Richard Horton
Editor
The Lancet
15. Srinath Reddy Kolli
President
Public Health Foundation of India
16. Peggy Liu
Chairperson
JUCCCE
17. Selina Lo
Senior Editor
The Lancet
18. Natasha Loder
Midwest Correspondent
The Economist
19. Wai Chiong Loke
Director of Development
Jurong Health Services
20. Sarah Molton
Senior Business Analyst
Wellcome Trust—Sustaining Health
21. Michael Myers
Managing Director
The Rockefeller Foundation
22. Samuel Myers
Research Scientist
Harvard School of Public Health
23. Sania Nishtar
President and CEO
Heartfile
24. Steven Osofsky
Executive Director, Wildlife Health & Health
Policy
Wildlife Conservation Society
25. Subhrendu Pattanayak
Professor, Public Policy & Environment
Duke University
26. Montira Pongsiri
Environmental Scientist
Environmental Protection Agency
27. Judith Rodin
President
The Rockefeller Foundation
28. Timothy Shorten
The Lancet
29. Agnes Soucat
Director, Human Development
African Development Bank
30. Vijay Vaitheeswaran
China Business Editor
The Economist
31. Peter Ward
Professor of Geobiology
University of Adelaide
32. Sarah Whitmee
Postdoctoral Researcher
University College London – CBER
33. Freya Williams
Executive Vice President
Edelman
34. Derek Yach
Founder
The Vitality Institute
The Planetary health meeting was convened by The Rockefeller Foundation and The Lancet
with support from The Rockefeller Foundation.