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Envisioning health systems in the planetary health era – a proposal for action

By guest contributors Renzo R. Guinto, Susannah Mayhew, Upasona Ghosh, and Shibaji Bose

Every two years, Health Systems Global (HSG), the international professional society for health policy and systems research (HPSR), holds the Global Symposium on Health Systems Research (HSR). While previous editions of the HSR have focused on important and often ‘wicked’ problems – accelerating universal health coverage (UHC), strengthening people-centred health systems, building resilience and responsiveness, the politics of health system performance, progressing the Sustainable Development Goals (SDGs), and promoting social justice – no symposia to date has focused explicitly on climate change or planetary health, and delegate submissions on health systems in a changing climate or responding to planetary health have remained few and far apart.

With the fresh announcement of the HSR2024 theme “Building Just and Sustainable Health Systems: Centering People and Protecting the Planet,” we, the leads of HSG’s Thematic Working Group on Climate Resilient and Sustainable Health Systems, see the ‘stage’ of the next global symposium as an opportunity to catalyse long-overdue engagement and attention to this issue among the broader HPSR community.

Health systems are confronting planetary breaches

The HPSR community is operating as if the climate is stable – it is not. As a human civilization, we are not on track to achieve the goals of the Paris Agreement, which means catastrophic health consequences in the long run to which today’s health systems are poorly equipped to respond. Meanwhile, apart from climate change, we are also confronting other problems driven by anthropogenic global environmental change, such as biodiversity loss, different kinds of pollution, the increasing risk of future pandemics, and the slow-burn antimicrobial resistance crisis. Scientists have already discovered that six of the nine identified planetary boundaries have been violated. The increasing recognition of these existential challenges led to the concept of “planetary health,” defined by the 2015 Rockefeller-Lancet Commission report as “the health of human civilization and the state of the natural systems on which it depends.”

We are also not on track to achieve the SDGs, which can only happen with more profound interconnectedness between sectors – including the health sector. Only seven years remain before the deadline, and we must find the strategies to accelerate progress – or even remedy the reversal of progress caused by the pandemic. Moreover, we must also begin deliberating on the post-SDG 2030 agenda, which must focus not on the symptoms but on the structural roots of human disease and environmental degradation. The UN Secretary-General has begun a new process around “Our Common Agenda,” and we believe that the planetary health vision must be its guiding framework.

Health systems will bear the brunt of the human health impacts of these planetary boundary breaches. They are already getting affected and responding to the health consequences of tropical cyclones, intense flooding, heat waves, wildfires, sea level rise, outbreaks of climate-sensitive infectious diseases, crop failures, and climate anxiety, to name a few. But health systems, as vital institutions of our contemporary civilization, also possess the power to adapt to these changes and usher in the “Great Transition” required to safeguard the health of humanity and the planet as articulated in the São Paulo Declaration on Planetary Health. Yet concerted and urgent efforts are needed to ensure that there is substantial research on how best to achieve climate-resilient and sustainable health systems – for instance, on how health systems can adapt to protect health amid a warming planet or how they can avoid being an accomplice to the climate crime and instead be a positive driver of societal decarbonization.

Solar panels on the rooftop of a hospital in the Philippines (Courtesy of Renzo R. Guinto)

HPSR community needs to act: 2024 symposium is an important opportunity

Next year’s symposium, HSR2024 in Nagasaki, is a critical opportunity to center our multiple evolving ecological crises in the HPSR agenda. Our professional community must begin this exercise of envisioning our health systems’ future in the planetary health era. Japan, a nation which has demonstrated deep respect for the natural world for centuries and has been pioneering many innovations that dramatically transformed our way of life, is well positioned to lead us in this HPSR revolution.

Many questions at the nexus of health systems and planetary health will require profound scholarship, robust conversations, and real-world iteration. Some of these areas that should be tackled during HSR2024 are as follows:

  • Developing novel strategies for health system adaptation and decarbonization – for example, by going beyond business continuity plans, reimagining new healthcare delivery models that are both resilient and low-carbon, profoundly reducing the environmental footprint of health systems, adapting operations to changing conditions (for instance, in response to climate-induced migration), embracing nature-based solutions through collaboration with other sectors, and ultimately contributing to equitable and sustainable health systems for all;
  • Creating policies that ensure that health systems worldwide continue to function towards achieving the goal of health equity for all (beyond the often narrowly defined concept of UHC), despite the challenges brought about by global environmental change, and that existing health inequities are not further exacerbated by the impacts of the planetary emergency or by health sector actions to mitigate and adapt to the climate crisis;
  • Building truly transdisciplinary and cross-sectoral collaborations, governance mechanisms, and learning systems that involve not only those stakeholders that are familiar to the health sector (such as social scientists, gender specialists, and public health professionals) but also those that engage very rarely with health professionals and health system scholars and practitioners (including climatologists, ecologists, engineers, climate activists, futurologists, etc.);
  • Exploring new ways to communicate planetary health messages through the health system and beyond, especially in the face of “infodemics;” meaningfully engage diverse communities that are disproportionately affected by environmental threats (for instance, climate migrants, cyclone victims, Indigenous Populations who are losing their homes, young people experiencing climate anxiety, among others), as well as those who have the power to solve the planetary crisis (for example, food and energy sectors, pharmaceutical companies that can “green” the entire medicine supply chain); and facilitate exchange between scientific and experiential knowledge coming from policy makers and communities;
  • Going beyond “tweaking” health systems to build “resilience” (which often leads to the retention of the status quo), and instead tackling the political economy of planetary health damage and driving futures-oriented adaptation and transformation not only to withstand environmental threats but also to drive positive global environmental, economic, and societal change for the long term – such as climate stabilization, degrowth, and sustainable peace.

The conference is happening a little over a year from now and, without a doubt, this agenda is of supreme urgency. The health of human civilization, including of future generations, lies in our decisions and actions today. We believe that the future of HPSR is one that is deeply connected and committed to the care not only of people but also of the planet. The intricate work towards building health systems that are “fit for purpose” in the planetary health era can be developed in Nagasaki – but it must begin now.

About the Authors

Renzo R. Guinto, Chair of Health Systems Global’s Thematic Working Group on Climate Resilient and Sustainable Health Systems, is the Inaugural Director of the Planetary and Global Health Program of the St. Luke’s Medical Center College of Medicine in the Philippines.

Susannah Mayhew, TWG Vice Chair for Europe, is a Professor in Health Policy, Systems, and Reproductive Health at the London School of Hygiene and Tropical Medicine.

Upasona Ghosh, TWG Vice Chair for Asia, is an Assistant Professor in environmental health and social and behavioural sciences at the Public Health Foundation of India.

Shibaji Bose, TWG Vice Chair for Asia, is a creative and visual research methods consultant working in the intersection of dominant and implicit narrative spaces in climate change, WASH and health systems.

Disclaimer: Views expressed by contributors are solely those of individual contributors, and not necessarily those of PLOS.

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