Planetary health and primary care: what’s the emergency?

Abstract

In 30 years’ time, the next generation will be angry with us. In the same way that we puzzle how past generations lived with great evils like slavery, they will wonder how we all watched our planet’s health decline and caused the greatest failure of humankind — overwhelming the resilience of the planet to support us. They will think we were selfish, wasteful, and reckless. There is still time to escape this greatest of failures. Planetary health is a new paradigm for health care1 and is a tough challenge for primary care. The old paradigm allowed the toxic mix of profligacy, profiteering, and politics to poison the planet. The effects of this mix have already littered the planet with the debris of human activity and labelled this epoch as the Anthropocene.1 The latest episode in this epoch is the Great Acceleration when both good and bad come faster. Our fast improving health care is matched by the fast worsening state of our planet’s natural systems. We are discovering how the planet’s capacity to support a stable environment for humankind has its limits. The natural systems that maintain planetary health are complex and complicated by poorly understood feedback loops, but human activity is accelerating disruptions in the climate system; the biogeochemical cycles; land use and land cover; and the availability of resources, including fresh water and arable land.2 By the time our privileged lives in high income countries feel harmed, there may be runaway changes that cannot be halted.2 These changes will damage population health with worse problems from nutrition, infectious diseases, non-communicable diseases, displacements and conflicts, and effects on mental health. The lens of medicine can zoom in to the most specialised studies of the human body or out to get the bigger picture in public …