The Lancet is not new to stimulate the debate in order to increase the awareness of all players involved in the health cycle. The basis of the Manifesto are already contained in the final report of the joint Commission supported by The Lancet and the London International Development Centre (LIDC) and published in 20102,3. The Commission analysed the achievement of the Declaration’s endpoints after ten years from its signature: despite many goals had already been reached or new modalities of actions were set forth in politics, sustainability and financing, the report recommended the need to overcome fragmentation and to create synergies and links between different goals of the Declaration and the possibility to introduce in the 2015’s revision new goals not yet considered. These, according to The Lancet, should be addressed towards the building of a revised framework for the Declaration, a framework ‘built of a shared vision of development across the life course rather than on separate goals and targets’.
A Manifesto for a Planetary Health
The Manifesto published by The Lancet calls to deeply reflect about the need to overcome the classical models of public health, which are based only on human needs, and to put direct attention and resources on the creation of an innovative model of ‘planetary health’: the future of the humanity is deeply linked to that of the ecosystem in which we are living in – the planet Earth. Apparently the new vision proposed by the magazine is very close to James Lovelock’s Gaia hypothesis, the living planet. The Lancet didn’t limit its action to the publication of the Manifesto: this has been paralleled by the possibility to sign on-line the Manifesto4. 7289 signatories have been collected at the moment we are writing (June 14th, 2014). The initiative aims to make more visible to global powers the social movement, too often hidden, which believes a better future should pass through different modalities to manage public politics.
The Manifesto is signed by Richard Horton, editor of The Lancet, and by a group of experts from the Auckland University, the London School of Hygiene and Tropical Medicine and the Umea University. Their position is clearly exposed in the very few first lines of the paper: ‘Our aim is to respond to the threats we face: threats to human health and wellbeing, threats to the sustainability of our civilisation, and threats to the natural and human-made systems that support us. Our vision is for a planet that nourishes and sustains the diversity of life with which we co-exist and on which we depend. Our goal is to create a movement for planetary health’.
The goal is ambitious, even more if we consider the audience to which the Manifesto is addressed: not only professional players of public health systems such as governments, international institutions and universities. A fundamental role should be played, according to The Lancet, by every single person ‘who has an interest in their own health, in the health of their fellow human being, and in the health of future generations’.
The idea of ‘planetary health’ was first introduced by Richard Horton – editor of The Lancet – in 20135. Horton takes into great attention the meaning of ‘global health’, a term currently used to signify coordinated modalities of political and economical interventions at a global level in order to sustain well-being and health for the human being. According to Horton, such activities would not take into account the planet Earth itself, which is the ‘substrate’ we are living on. The idea of planetary boundaries (see box) introduced by Rockström would not be sufficient, as it not includes socio-political and financial factors and the way they determine the human answers to the emerging hazards identified by the planetary boundaries model.
Collective awareness and responsibility
The message is clear: everyone in the world should be aware of the issues, needs and actions needed to ensure the sustainability of the health systems at a planetary level and should act by consequence in order to create a social movement that represents these positions to the economical and political parties involved in the decision-making processes.
The relevance of such a different way of thinking and acting in the public common space is evident if we consider the increasing number of environmental catastrophic events and their possible connection to distorted soil usage and to too high levels of pollution. The Chines population, just to make an example, is mostly living within a semi-permanent ‘chemical fog’, so hard to solve that sunset’s projections have been organised in order to remind them the existence of the sun and of the beautiful of Nature. Architects are also projecting new cities ‘wrapped up in a bubble’: the inside air would allow survival and health, while the external environment would be continuously stressed by unbearable levels of pollution. No matter to say these models of future development take into consideration the human being only, not its close correlations with the environment.
One of the major goals of the Manifesto is to push people towards a deep reflection on this kind of issues: if the humanity will continue to favour its own interest instead of researching a better equilibrium – which shall include all the components making the ‘Earth system’ our truly home – the future of the planet might degenerate in a short while.
What The Lancet suggests is to deeply rethink our philosophy of life towards new values, which shall include planetary health as a primary component. This vision is not too far from the holistic one typical of the oriental philosophic systems, for which man is only a part of a wider interconnected natural system.
Horton and colleagues highlight in the Manifesto the need to put ‘people, not diseases, and equity, not the creation of unjust societies’ at the centre of the political and economical action. Health politics play a crucial role in such a contest and should include collective actions, as they wrote: ‘We need a new vision of cooperative and democratic action at all levels of society and a new principle of planetism and wellbeing for every person on this Earth – a principle that asserts that we must conserve, sustain, and make resilient the planetary and human systems on which health depends by giving priority to the wellbeing of all. [….] Together with empowered communities, we can confront entrenched interests and forces that jeopardise our future. A powerful social movement based on collective action at every level of society will deliver planetary health and, at the same time, support sustainable human development’.
From theory to practice
The Manifesto also highlights the danger in thinking that progress will never stop and criticises the over-consumption model of society. According to the authors, this model is unsustainable and might be reversible, causing a regression in the current health and wellbeing conditions, which were the a major gain for humanity in the past two centuries.
A severe criticism comes from The Lancet towards economical and geopolitical equilibriums currently governing the world: ‘The idea of unconstrained progress is a dangerous human illusion: success brings new and potentially even more dangerous threats. Our tolerance of neoliberalism and transnational forces dedicated to ends far removed from the needs of the vast majority of people, and especially the most deprived and vulnerable, is only deepening the crisis we face. We live in a world where the trust between us, our institutions, and our leaders, is falling to levels incompatible with peaceful and just societies, thus contributing to widespread disillusionment with democracy and the political process’.
The proposal of the authors for a better and more sustainable future points towards the need to recognise the interdependence and the interconnectedness of the risks we face. They ask for an independent accountability as an essential instrument to monitor and review the commitments and the remedial actions set forth by the governments. Such an instrument is not yet available and this could contribute, according to The Lancet, to the failure of many politics.
2015 is not far away: we will follow up the revision of the Millennium Declaration to verify whether the many criticisms and suggestions of the Manifesto will be considered and included in the revised Declaration.
Planetary Boundaries
The idea of ‘planetary boundaries’ dates to a paper published in 2009 (Ecology and Society6) and signed by a group of international researcher led by Johan Rockström.
The paper examines factors involved in the generation and increasing of the anthropogenic pressure. As this pressure is continuously increasing, it could not be excluded – according to the authors – that Earth might be subject to unexpected and catastrophic environmental transformations.
The planetary boundaries represent the space within which the humanity can safely live and operate, while crossing one or more boundaries may lead to non linear environmental responses and to not predictable consequences, even at a planetary scale.
The paper identifies nine planetary boundaries, seven of which have been quantified on the basis of current scientific evidence: climatic changes, oceans acidification, stratospheric ozone levels, biogeochemical nitrogen and phosphorous cycles, use of global hydric resources, methods of soil usage and speed in loss of biodiversity. Chemical pollution and atmospheric aerosol’s charge are two boundaries not yet quantifiable.
According to the report, three of the nine boundaries have been already passed: climatic changes, loss of biodiversity and global nitrogen cycle. The social impact and consequences are not yet predicable, and a chain reaction might be activated towards the passing of other boundaries.
Bibliography
1. R. Horton et al., From public to planetary health: a manifesto, The Lancet, v. 383, p. 847 (2014), doi:10.1016/S0140-6736(14)60409-8
2. The Millenium Development Goals: a cross-sectorial analysis and principles for goal setting after 2015, The Lancet, v. 376 (2010), doi:10.1016/S0140-6736(10)61196-8
3. Equity as shared vision for health and development, The Lancet, v. 376, p. 929 (2010), doi:10.1016/S0140-6736(10)61431-6
4. Online page to sign the Manifesto: http://preview.smartfocusdigital.com/go.asp?/.2014.digitalmarketing.planetaryhealth.homepage/bELA001
5. R. Horton, Offline: Planetary health – a new vision for the post-2015 era, The Lancet, v. 382, p. 1012 (2013), doi:10.1016/S0140-6736(13)61936-4
6. J. Rockström et al., Planetary Boundaries: Exploring the Safe Operating Space for Humanity, Ecology and Society 14(2): 32. [online] URL: http://www.ecologyandsociety.org/vol14/iss2/art32/