Table Of ContentPLANETARY HEALTH
Safeguarding Human Health and the Environment in the Anthropocene
We live in unprecedented times – the Anthropocene – defined by far-reaching
humanimpactsonthenaturalsystemsthat underpincivilization.PlanetaryHealth
explores the many environmental changes that threaten to undermine progress in
human health, and explains how these changes affect health outcomes, from
infectious diseases (including pandemics) to child development to mental health,
fromchronicdiseasestonutritiontoinjuries.Itshowshowpeoplecanadaptatleast
partly to those changes that are now unavoidable, through actions that both
improve health and safeguard the environment. But humanity must do more than
just adapt: we need transformative changes across many sectors – energy, built
environment, transport, manufacturing, food, and health care – to reduce the
environmentalfootprintsofsociety.Thebookdiscussesspecificpolicies,technolo-
gies, and interventions to achieve the scale of change required, and explains how
these can be implemented. It presents the evidence, builds hope in our common
future, and aims to motivate action by everyone, from the general public to policy-
makers to health professionals.
andy haines is Professor of Environmental Change and Public Health at the
Centre for Climate Change and Planetary Health, London School of Hygiene and
Tropical Medicine, where he was previously director between 2001 and 2010. He
was a member of the Intergovernmental Panel on Climate Change for the Second,
Third, and Fifth Assessment Reports. He was chair of the Task Force on Climate
Change Mitigation and Public Health in 2008–9, and of the Rockefeller
Foundation–Lancet Commission on Planetary Health in 2014–15. He is an inter-
national member of the US National Academy of Medicine.
howard frumkin is Professor Emeritus of Environmental and Occupational
Health Sciences at the University of Washington School of Public Health in
Seattle, where he was dean from 2000 through 2006. He was previously head
of the Wellcome Trust ‘Our Planet, Our Health’ initiative, and director of the
National Center for Environmental Health at the US Centers for Disease Control
and Prevention.
‘This book illustrates the dramatic change in humanity’s awareness about the realities of
ourworldandourdestiny.PlanetaryHealthdescribesthetransformationthatwillmoveus
toa healthier, safer,and more sustainable future,withhope, optimism, and confidence.’
Gro Harlem Brundtland, former Prime Minister ofNorway and
formerDirector-General ofthe World Health Organization
‘The climate crisis and other environmental challenges pose growing threats to the con-
tinuedhealthofhumanity.AndyHainesandHowieFrumkin’sbookcogentlyandaccess-
ibly summarizes these growing threats to human health, and outlines the transformative
changes we need to enact to improve health around the world and at the same time safe-
guard the environment for our children and grandchildren. This book is essential reading
for every decision-maker in government and NGOs formulating health or environmental
policy. The book is also a wonderful overview of planetary health issues for the general
reader and student. A more important topic for the future of humanity from two leading
expertsis hardto imagine. Avery timely analysisof thecentralissuesof ourtime.’
Helen Clark, former Prime Ministerof New Zealand and
formerAdministratorof theUnited NationsDevelopment Programme
‘A splendid and important piece of work. Andy Haines and Howard Frumkin have, over
manydecades,ledtheworldintheunderstandingoftherelationshipsbetweenenvironment
andhealth.Inthiscruciallyimportantbook,theyshowhowourdestructivebehaviour,ona
hugescale,hasunderminedourenvironmentinwaysthatfosterpandemicsandinfectious
diseases, and which profoundly damage our physical and mental health. They also show,
through careful and evidence-based analysis, how we can transform how we live, work,
andconsumetonotonlyrestoreourenvironmentbutalsoliveinmuchhealthierandmore
enjoyableways.’
ProfessorLord Nicholas Stern, LondonSchoolofEconomics
‘Andrew Haines and Howard Frumkin are two of the modern giants in planetary health.
Theirbookhighlightsthevalueofcross-cuttingapproachestohumanhealthandthehealthof
the environment, combining resilience, health, equity, and prosperity. The book highlights
the potential for the topic ofplanetary healthtotransform highereducation,helping usrise
to the challenge of multiple global crises. As we emerge from a global pandemic, I cannot
imagineamoretimelyandimportanttopic.Anamazing,brilliantlyarguedcompendium.’
Judith Rodin,former Presidentof theRockefeller Foundation and
former President ofthe University ofPennsylvania
‘Byitsverynature,planetaryhealthisavastandmultidisciplinarysubject.Ourunderstand-
ingofthefieldisconstantlyexpanding,ourapproachestoaddressingitrapidlyevolving,and
the political landscape surrounding it increasingly complex, and yet, Haines and Frumkin
masterfully summarize the issue in all of its complexity, leaving the reader with a solid
foundationofessential knowledge and – moreimportantly – hope, and a clearly delineated
pathforward.’
Michele Barry MD, Directorof theCenter for Innovationin
Global Health, Stanford University
‘TheAnthropoceneEra.Ourchildrenandourchildren’schildrenwillbeastonishedthatthe
firstfullycomprehensivebooktodescribetheireverydaylifewasnotwritten‘til2021.And
astheyreflectonwhatSirAndyHainesandHowardFrumkinhavelaidout,eithertheywill
ask why did we not follow the ideas for transformative change in this book, or they will
stand together in hope saying, humanity took heed, it listened to evidence and common
sense,andwewereabletotilttheEarth’ssystemsontheiraxis.Thisbookisawatershed,
itsintegratedsciencecombinesseparatestrandsofknowledge,andcreatesthespaceforfar
moreequitableparticipationinandownershipoftheactionsneeded.Thisbookispublished
at a watershed moment in history, when the health of the planet is in our hands. Can
PlanetaryHealthbecome ourzeitgeist?’
LizGrant,University of Edinburgh
‘Sir Andy Haines and Howard Frumkin’s book Planetary Health: Safeguarding Human
Health and the Environment in the Anthropocene is a fact-filled and thought-provoking
volumethatexplainstheoriginsandproposessoundsolutionstotheexistentialcrisesofthe
Anthropocene Era. The authors describe the political, economic, technological, and ideo-
logical choices, often motivated by greed and science denial that throughout history have
broughtustoapointwherethecontinuedsurvivalofhumansocietiesisnowunderthreat.
Theydemonstratehow,afterimprovingthehealthofhumansocieties,wehaveinthespan
of a few decades prepared for its regression, by destroying billions of years of stable
climate evolution. Instead of protecting the Earth, we have exploited it wrongly and
excessively,pollutedit,andcreatedirreversibledamagethathasincreasedsocioeconomic
inequities and fallen most heavily upon the world’s poor. This book offers a holistic
approachthathelpsusunderstandwhywemustrespect,protect,andenforcemulti-sectoral
frameworksifwearetomaintaintheintegrityoftheuniqueintegratedcomplexsystemthat
istheEarth.Thebookalsodescribesthemanyactionseachofuscanchoosetotake,across
sectors and within the finite planetary boundaries and cultural context, to reverse and
reduce thecurrentrisksto a minimumand toremainhealthy. An importantread!’
AgnesBinagwaho, Vice Chancellorof theUniversity of
Global HealthEquity inRwanda
‘Abrilliantbook: planetary health, defined by foundersof the field.’
Tony Capon,Director ofthe MonashSustainable Development Institute and
ProfessorofPlanetary Health inthe School of Public Health and
PreventiveMedicine atMonash University
PLANETARY HEALTH
Safeguarding Human Health and the Environment
in the Anthropocene
ANDY HAINES
LondonSchoolofHygieneandTropicalMedicine
HOWARD FRUMKIN
UniversityofWashington
UniversityPrintingHouse,CambridgeCB28BS,UnitedKingdom
OneLibertyPlaza,20thFloor,NewYork,NY10006,USA
477WilliamstownRoad,PortMelbourne,VIC3207,Australia
314–321,3rdFloor,Plot3,SplendorForum,JasolaDistrictCentre,NewDelhi–110025,India
103PenangRoad,#05–06/07,VisioncrestCommercial,Singapore238467
CambridgeUniversityPressispartoftheUniversityofCambridge.
ItfurtherstheUniversity’smissionbydisseminatingknowledgeinthepursuitof
education,learning,andresearchatthehighestinternationallevelsofexcellence.
www.cambridge.org
Informationonthistitle:www.cambridge.org/9781108492348
DOI:10.1017/9781108698054
©AndyHainesandHowardFrumkin2021
Thispublicationisincopyright.Subjecttostatutoryexception
andtotheprovisionsofrelevantcollectivelicensingagreements,
noreproductionofanypartmaytakeplacewithoutthewritten
permissionofCambridgeUniversityPress.
Firstpublished2021
PrintedintheUnitedKingdombyTJBooksLimited,PadstowCornwall
AcataloguerecordforthispublicationisavailablefromtheBritishLibrary.
ISBN978-1-108-49234-8Hardback
ISBN978-1-108-72926-0Paperback
CambridgeUniversityPresshasnoresponsibilityforthepersistenceoraccuracy
ofURLsforexternalorthird-partyinternetwebsitesreferredtointhispublication
anddoesnotguaranteethatanycontentonsuchwebsitesis,orwillremain,
accurateorappropriate.
Contents
Preface page xi
Acknowledgements xvi
1 Our Changing Planet 1
The Long Arc of Human History 2
Human Thriving in the Great Acceleration 3
A Changing Planet 5
Planetary Boundaries 13
Inequities in Greenhouse Gas Emissions and Environmental
Footprints 23
Globalization, Development, and Changing Environmental Footprints 23
The Roots of the Anthropocene 26
The Path Forward 28
References 29
2 Climate Change 34
The Foundations of Knowledge about Climate and Health 35
The Impacts of Climate Change on Human Health and Well-Being 44
References 65
3 Pollution, Land Use, Biodiversity, and Health 77
Pollution: A Multidimensional Challenge 77
Air Pollution 78
Microbial Contamination of Water 85
Chemical Pollution 86
Land Use Change, Biodiversity Loss, and Disease Risk 97
Freshwater Resources 109
Multiple Drivers of Disease Risk 110
References 112
vii
viii Contents
4 Assessing Vulnerability and Risk in the Anthropocene Epoch 125
Climate Risk Assessments 127
National Risk Assessments 132
Local Vulnerability and Risks 137
The Influence of Social and Demographic Factors on Risk 138
The Paradox of Intensifying Environmental Changes and
Improving Health 142
Assessing the Adaptation Gap 143
References 144
5 Adaptation and Resilience to Planetary Change 148
Adaptation and Resilience: Companion Concepts 148
Adaptation 149
Resilience 152
Adaptation and Resilience in Practice: Five Examples 159
Nature-Based Adaptation 165
Progress in Adaptation and Resilience 167
Trade-offs and Limits to Adaptation 170
Financing Adaptation 171
References 173
6 Addressing Conceptual, Knowledge, and Implementation
Challenges 178
Conceptual Challenges 179
Knowledge Challenges 201
Implementation Challenges 206
References 208
7 Health in the Sustainable Development Goals 213
The Millennium Development Goals 213
The Sustainable Development Goals 216
Health in the SDGs 218
Challenges in Monitoring Progress 224
Opportunities for Multiple Benefits across the SDGs 226
Financing the SDGs 227
The Limitations of the SDGs 228
The Way Forward 230
References 231
