Healthy Planet, Healthy People: Taking a Balanced Approach to International Development

Do you know how climate change, ecological damage, biodiversity, and global health programs relate? If you are like me, you know that these environmental factors impact human health, but you may not have thought about how to address them in your work. To understand these issues in more depth, I moderated a webinar on June 30 about how we can apply planetary health thinking to development interventions and the prevention of future pandemics. I was proud to be joined by planetary health advocate Renzo Guinto and my colleague Kathy Wachala, Biodiversity Conservation and Natural Resource Management Specialist at RTI.

Planetary health, for those unfamiliar, is an emerging field that examines how the health of people and our planet are interlinked. My biggest takeaways as a public health professional were the concepts of “planetary boundaries” and “Doughnut Economics.” The planetary boundaries framework posits that there are nine ecological thresholds that, once breached, will make planet Earth less conducive for human survival. Meanwhile, Doughnut Economics, proposed by Oxford economist Kate Raworth, envisions a new economic model that protects the planetary boundaries while meeting the basic needs of people.

These concepts are somewhat at odds with our approach to international development, which at times emphasizes the benefits of macroeconomic growth in low- and middle-income countries above other factors. This ethos is apparent in discussions I have had with ministries of finance, and even health, who highlight the need for investment cases and Return on Investment (ROI) calculations to evaluate health interventions, as macroeconomic indicators drive most investment decisions.

Too often, we, as development practitioners, think that economic growth, whether ecology is protected or not, leads to improved health. Planetary health encourages us to think beyond this limitless growth mentality. A key idea Renzo and Kathy kept coming back to was “balance” – balance between human, animal, and environmental needs; economic growth and ecological protection; and devotion to evidence-based approaches and openness to uncertainty. Renzo’s presentation reminded us that a host of environmental, cultural, and individual factors also support strong health outcomes. So how do we look more holistically at health, as not just a determinant and a product of economic growth, but as a real manifestation of balance?

First, Renzo noted that both “ecology” and “economy” derive from the Greek word “eco,” meaning “home.” From the planetary health perspective, balancing ecological protection with economic growth is about how we ensure that our home is both safe for us to live in and provides us with what we need to live. Making that case to our counterparts in ministries of finance, environment, or health requires showing that maintaining ecological balance will improve human health in the long run, whether that is something as simple as planning for the disposal of Personal Protective Equipment (PPE), using bikes for transportation to reduce carbon dioxide emissions, or even promoting vegetarian meals in nutrition programs. From a donor perspective, we could consider further investment in telecommunications and software development, which do not involve heavy industry and therefore allow for advancement with a reduced economic burden. Rather than zeroing in on one approach, a holistic approach to development permits innovation around these technological options where a “multiplier effect” is possible.

Renzo and Kathy also talked about how health systems are still focused on individual care and the environment is viewed as merely an externality. For example, we often use patient- or client-centric models to think about service integration or supply chain functions. Even our ecological models, such as those that depict the social determinants of health, are centered on the individual. What if instead we put the global community, including animals and the broader environment, at the center of such models? 

If we re-center our models in this way, what tools and data could global health practitioners use to inform which health outcomes are important? We have access to vast amounts of client and facility level data from demographic and health surveys, routine facility data collection, and health insurance claims, but what are we doing to collect information on environmental determinants that also affect health? How could we analyze it through a planetary health lens?

Planetary health principles could also help us reassess macroeconomic indicators that drive resource allocation and determine how well they balance economic growth and environmental sustainability. What if, instead of using GDP per capita to measure countries’ progress, we adopted more holistic measures, such as Bhutan’s Gross National Happiness? Would it change the way we approach country assessments, technical assistance, and resource allocation?

We have also seen that human encroachment into otherwise wild areas, industrial meat production, and illegally trafficked wildlife can all contribute to the spread of zoonotic pathogens. Devoting more resources to biodiversity conservation and environmental protection efforts that complement biomedical interventions could better position the development community to regulate human-animal interactions and prevent future pandemics like COVID-19. Renzo also reminded us that reducing meat consumption could lead to less heart disease and other noncommunicable diseases, decrease greenhouse gas emissions, and reduce the risk of antimicrobial resistance. Hence, he called the predominantly plant-based “planetary health diet” proposed by the EAT-Lancet Commission a “quadruple win” for planetary health. Would promoting a planetary health diet in nutrition programs, for example, have a positive impact on the health of both people and the planet?

It was helpful that Renzo reminded us that “every sector is a health sector.” If we truly incorporate multisectoral approaches into our mental model of public health, then new possibilities for tackling the drivers of ill health emerge. The options for addressing the health impacts of agriculture, the built environment, and animal production, both negative and positive, are numerous and multi-faceted.

For the global health community, we should think about how to move from our focus on narrow health outcomes towards more holistic measures of assessing public and planetary health. Then we must devise creative ways to communicate this holistic vision to governments and donors to channel resources in ways that improve the health of people and the planet, both during the COVID-19 pandemic and beyond.