The future One Sustainable Health Institute – time to stop longstanding injustices in health

By guest contributor Renzo R. Guinto, MD DrPH, Section Editor for Planetary and Environmental Health, PLOS Global Public Health

During this year’s World Health Summit in Berlin, Germany, I had the opportunity to participate in a closed-door by-invitation-only roundtable dialogue organized by One Europe for Global Health and the One Sustainable Health (OSH) For All Foundation. The event is about the proposal to establish a One Sustainable Health Institute – I am sure that like me, you are also wondering what it means and what it will do. Since early this year, I have been involved in an international process led by the OSH Foundation – I co-chair one of its six international working groups, the one focusing on the future of human-nature relations. Before #WHS2023, our group convened in July 2023 in Lyon, France to further flesh out the “One Sustainable Health” agenda, which some describe as “putting an end to the One Health-planetary health debate” while others skeptically view as another term to be added to our growing academic glossary.

Nonetheless, whether we like the idea or not, it is important that we keep an eye on these developments and actively participate in these processes. That is why I did not hesitate to be in the “room where it happens,” quoting the popular Broadway musical Hamilton. In this roundtable, I was one of the very few (you can count with the fingers of one hand) coming from the Global South, from outside of Europe, and from age 40 and below – admittedly, I really felt like an outsider. However, I decided to roll up my sleeves, sit with my European friends, and share a different perspective that they will not be able to hear at all if I were not in the room in the first place.

During the roundtable, I was asked about my thoughts – how should a future One Sustainable Health Institute look like? My European colleagues, some of them the usual suspects, made an enumeration of the usual answers – it must be “transdisciplinary”, “data-driven”, “policy-oriented,” “innovative.” Many health institutes around the world already possess many of these nice (and legitimate) characteristics.

But for me, there are three ingredients that I hope will serve as the foundation of the OSH Institute of the future – the wisdom of the Global South, the power of communities, and the energy of youth.

First, the wisdom and experience of the Global South. During this year’s World Health Summit (and all the previous ones I attended), and in every One Health/planetary health convening that I participated in since the beginning of my career, everyone has said, “We must engage the Global South.” But it will never happen if the general notion that knowledge and expertise only flow from North to South is not totally dismantled. The Global South, or low- and middle-income countries, is an untapped treasure chest not only of knowledge (including Indigenous knowledge), but also talent and expertise of their citizens. There must be a multidirectional flow of knowledge and expertise in a new OSH system, where knowledge is created not through parachute or even parasitic research, but through equitable and respectful partnerships supported by adequate and fairly allocated resources – a vital component of the decolonization of global/One/planetary health and of science as a whole.

Second, the power and potential of communities. Same as for the first ingredient, I have heard “centering community voices” in every session of the entire World Health Summit – but where are the community voices? In one session on mental health, an old, white, Western professor was presenting about the mental health triumphs of young, black Africans whose photos were flashed on the slides. “Why are they not here to tell their stories themselves?” I was cringing in my seat. Communities have always been seen as guinea pigs for experiments and beneficiaries of charity, not as wellsprings of solutions and co-producers of health and wellbeing. In my Planetary and Global Health Program at St. Luke’s Medical Center in the Philippines, my amazing, talented, and youthful team composed of next generation “pracademics” from diverse disciplines is working closely with local communities in building climate-resilient local health systems in coastal municipalities, which are now experiencing cyclones, drought, and sea level rise. Local leaders and community members are our teachers and fellow researchers – because they know the issues, interventions, places, and people by heart. The future OSH Institute must not sit comfortably in “international Geneva” or “cosmopolitan New York,” detached from the realities in the frontlines of climate change and pandemics, and instead be closely located – both physically and epistemologically – to the communities that the science and practice of OSH ought to serve.

Third, the energy and entrepreneurship of youth. Frankly, there has been a lot of paying lip service to and tokenism of young people – at the World Health Summit, in other global/One/planetary health conferences, or even in UN climate conferences or UN General Assembly SDG summits. The first youth envoy of the UN climate negotiations, Omnia El Omrani, who I am proud to call as my sister, comrade, and friend, highlighted during the opening of #WHS2023 the importance of meaningfully engaging young people in advancing health for all – not a new message, but certainly needs to be repeated again and again. Young people today may already be experiencing the new phenomenon of “climate anxiety,” but they are still very much committed to fix the mess that the generations before them have created. Young people are creative and entrepreneurial, they are digitally connected, they have informal yet widespread networks – and they are also studying in universities and building their start-ups to elucidate complex challenges and co-incubate lasting solutions. But they are given very few seats around the table – they are hired in low-paying postdoctoral jobs within toxic academic environments, their social enterprises are not supported with sustainable funding, and they have very little say in the leadership and governance of institutions at all levels, from research institutes to national ministries to the World Health Organization. To give a glimpse of what could be, my three-year-old planetary health team in the Philippines has a maximum age of 35 years – that is my age today. We get to do really cool stuff that will change the world, and we are doing it in a very fun way. We must capitalize not only on young people’s anxiety and anger, their dissatisfaction towards the status quo – but also their devotion to not repeating the mistakes of the past and their genuine concern for future generations who are yet to be born.

So how do we harness the wisdom of the Global South, the power of communities, and the energy of youth as we build the OSH Institute of the future? There are three things that politicians, policymakers, academic leaders, program implementers, and funders must do – listen to them, invest in them, and put them in the center – not in the periphery – in the arena of action. In the next roundtable, I must not be solo anymore – in fact, our numbers must be double, or many times greater than the ones sitting with me in that Berlin hotel room.

Finally, while the institutional design of the future OSH Institute is yet to be deliberated – and I hope that in this phase, the voices of the three groups that I earlier described are genuinely integrated into the discourse – the institute will no doubt have a leader at the top, the one who will set the direction, manage the organization, and serve as an example. I fervently hope that we will not reproduce the injustices in global health leadership that we have seen for the past decades. Instead, the future OSH Institute must appoint an inaugural leader who comes from the Global South, who has a strong background in community science and activism, and perhaps who is below the age of 40 too.

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About the author:

Section Editor for PLOS Global Public Health’s Planetary and Environmental Health section, Renzo R. Guinto, MD DrPH is the Associate Professor and Inaugural Director of the Planetary and Global Health Program (PGHP) of the St. Luke’s Medical Center College of Medicine in the Philippines. The St. Luke’s PGHP is the inaugural winner of the CUGH-Velji Planetary Health Innovation Award given by the Consortium of Universities for Global Health (CUGH). This essay is an expanded version of the statement that Renzo delivered during the roundtable. He can be reached via his LinkedIn and Twitter accounts.

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