- Email: [email protected]
Planetary health: a call for papers
Comment
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Laxminarayan P, Kanathala S, Gangrade M, Kankan R, Ramachandra R. Novel crystalline polymorphic form of a camptothecin analogue. India Patent 255388, issued Feb 22, 2013. http://ipindiaservices.gov.in/patentsearch/GrantedSearch/ ReportProjectPopUp.aspx?Appl_No=1274%2fMUM%2f2005&Pbl_ No=1274%2fMUM%2f2005&Pat_No=255388 (accessed May 22, 2014). Anon. Pharma exports rise 10.50% to $14·6 bn in FY’13. The Hindu Business Line 5 June 2013. http://www.thehindubusinessline.com/ industry-and-economy/pharma-exports-rise-1050-to-146-bn-in-fy13/ article4784677.ece (accessed Jan 23, 2014). India—Parliamentary Standing Committee on Health and Family Welfare. Fifty-ninth report on the functioning of the central drugs standard control organisation. http://164.100.47.5/newcommittee/reports/ englishcommittees/committee%20on%20health%20and%20family%20 welfare/59.pdf (accessed Jan 23, 2014).
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United States Department of Justice. Generic drug manufacturer ranbaxy pleads guilty and agrees to pay $500 million to resolve false claims allegations, cGMP violations and false statements to the FDA. http://www. justice.gov/opa/pr/2013/May/13-civ-542.html (accessed Jan 23, 2014). Eban K. Dirty medicine. May 15, 2013. http://features.blogs.fortune.cnn. com/2013/05/15/ranbaxy-fraud-lipitor/ (accessed Jan 23, 2014). Eban K. The latest to claim fraud at generic Lipitor maker Ranbaxy: its owners. http://features.blogs.fortune.cnn.com/2013/05/23/ranbaxylipitor-fraud/ (accessed May 2, 2014).
We live in the Anthropocene era when humanity’s impact on both biological and geophysical systems is becoming increasingly dominant. Environmental trends, including large-scale changes to climate, water, and natural habitats, pose important challenges to sustaining the biosphere in a state conducive to the advancement of health and flourishing of humanity. Those challenges also threaten the very viability of human civilisation.1 The UN Intergovernmental Panel on Climate Change (IPCC) has assessed the risks to health from climate change, but much less has been written on the health effects of the other environmental changes or on the implications for health from interactions between different types of environmental stress. Biodiversity loss, freshwater withdrawals, cropland and pasture conversion, coastal buffer degradation, and ocean acidification have major implications for human health through effects on a range of health outcomes that include: water-related and vector-borne diseases; impacts of increased frequency and intensity of extreme events, such as floods, droughts, and heatwaves; and food security and undernutrition. Beyond these direct and ecologically mediated impacts, cultural and aesthetic deprivation, livelihood losses, population displacement, conflict, poverty, and ultimately collapse of our civilisation are of added concern. There is evidence, for example, that increased thermal stress will substantially reduce labour productivity in tropical and subtropical regions and earnings of subsistence farmers because of declining crop yields, thus increasing poverty.2 However, the nature and extent of many of these indirect pathways have yet to be successfully quantified. A major concern is the potential for many environmental stressors to influence agricultural productivity, freshwater provision and sanitation, biomass fuel www.thelancet.com Vol 384 August 9, 2014
burning and ambient air pollution, the incidence and distribution of climate sensitive diseases, and nutrient and waste absorption and detoxification. For example, a systematic review of more than 1000 studies concluded that “climate change is a threat to crop productivity in areas that are already food insecure”.3 Although increasing concentrations of carbon dioxide can stimulate growth in some crops, especially C3 crops such as wheat and rice, they can also adversely affect their nutritional quality. For example, a meta-analysis of 228 experimental studies showed decreases in protein content of 10–14% in edible portions of wheat, rice, barley, and potato, but decreases of only 1·5% in soybeans when they are grown in elevated atmospheric carbon dioxide.4 Recent evidence indicates that increasing concentrations of carbon dioxide in the atmosphere also lower the amount of micronutrients, notably iron and zinc, in the edible portions of food crops such as wheat, rice, and soybeans.5 About 2 billion people globally have deficiencies of these micronutrients and a large proportion of the human population depends on these types of food crops for much of their dietary intake. These changes are, therefore, likely to have substantial health and societal impacts. Intensive farming with large quantities of fertilisers, pesticides, and freshwater to offset these yield and nutritional declines can, in turn, cause serious offsite and downstream environmental damage. To assess the health effects of complex ecological alteration we need to better understand not only how changes in each system will affect health, but also how changes in different systems might interact over different timescales (both positively and negatively), and the extent to which adaptation (either spontaneous or planned) could reduce adverse effects on health. Improving our understanding of the complex linkages
Science Photo Library
Planetary health: a call for papers
To submit an abstract online go to http://ees.elsevier.com/ thelancet/default.asp
479
Comment
between human health and planetary health— the health of human civilisations—necessitates assessment of current and future health impacts of specific environmental changes and their interactions, while taking into account the varying vulnerability of populations and individuals. The Lancet–Rockefeller Foundation Commission on Planetary Health has been set up to assess the potential implications for health of multiple changes in the Earth’s “essential life support systems”,6 with the aim of publishing its assessment in mid-2015. The Commission has the opportunity to add value to previous initiatives, such as the Millennium Ecosystem Assessment, the IPCC, and other Lancet Commissions and Series by developing an interdisciplinary assessment of the complex interlinkages between environmental sustainability and health. However, it is essential to move beyond a restatement of the problems towards potential policy solutions, which can move humanity towards a more sustainable course within the finite, but uncertain, limits of exploitation of planetary resources and the capacity of ecosystems to absorb the wastes of the current world economy. Such an endeavour requires assessment of the scientific evidence on the risks to health and how to reduce them, with full recognition of the persistent gap between our unprecedented knowledge of diseases and the implementation of that knowledge, especially in developing countries.7 We also need to better understand the challenges to governance and current economic orthodoxy posed by inequitable and unsustainable patterns of development. Lessons from history about how communities, countries, and civilisations have addressed profound ecological change—or failed to do so—could have resonance for today. Innovative science is also needed to help decision makers because our scientific understanding of many of the complex interlinkages, contexts, and efficacy of solutions will remain imperfect, incomplete, and uncertain. We invite the submission of innovative and rigorous research that addresses the topic of global environmental change, ecosystem impairment, and the health of human civilisations. There will be a two-stage process for assessment of potential papers. The first stage involves the submission of a 300 word structured abstract outlining the objective, data sources, methods, and main conclusions of the study. This should be submitted by Oct 13, 2014, through The Lancet’s online submission 480
system referencing Lancet–Rockefeller Planetary Health. After a rapid triage process, selected researchers will be invited to submit full papers by Dec 23, 2014. These will be peer reviewed and those papers (an estimated two to four papers) that are deemed the most important and rigorous will be published alongside the Commission report. Defining appropriate case studies that can illustrate these challenges and how to address them will be essential to make the Commission’s report interesting and accessible to a wide audience. The Commission is, therefore, also interested to receive case reports of 350–700 words that illustrate one or more of the following: the impacts of, and vulnerability to, global environmental change; the effects of adaptation strategies to reduce impacts and promote resilient societies; the potential for health cobenefits of strategies to prevent environmental change in specific countries/communities. These case reports should be based on high-quality data that can be made available in the public domain and are derived from authenticated sources. The case studies will also be peer reviewed and may be published within the Lancet Commission report or in the web appendix accompanying the report. We aim to raise the profile of these issues within the research and wider global health community, as well as to stimulate collaborations between health, environmental, and other relevant disciplines to advance our understanding of both the threats and potential solutions to these pressing problems. Andy Haines, *Sarah Whitmee, Richard Horton Department of Social and Environmental Health Research and Department of Population Health, London School of Hygiene & Tropical Medicine, London, UK (AH); Centre for Biodiversity and Environment Research, Department of Genetics, Evolution and Environment, Division of Biosciences, University College London, London WC1E 6BT, UK (SW); and The Lancet, London, UK (RH) [email protected] We declare no competing interests. 1 2 3 4
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Horton R. Offline: Reimagining the meaning of health. Lancet 2014; 384: 218. Dunne JP, Stouffer RJ, John JG. Reductions in labour capacity from heat stress under climate warming. Nature Climate Change 2013; 3: 563–66. Knox J, Hess T, Daccache A, Wheeler T. Climate change impacts on crop productivity in Africa and South Asia. Environ Res Lett 2012; 7: 034032. Taub DR, Miller B, Allen H. Effects of elevated CO2 on the protein concentration of food crops: a meta-analysis. Global Change Biol 2008; 14: 565–75. Myers SS, Zanobetti A, Kloog I, et al. Increasing CO2 threatens human nutrition. Nature 2014; 510: 139–42. Horton R, Beaglehole R, Bonita R, Raeburn J, McKee M, Wall S. From public to planetary health: a manifesto. Lancet 2014; 383: 847. Sanders D, Haines A. Implementation research is needed to achieve international health goals. PLoS Med 2006; 3: e186.
www.thelancet.com Vol 384 August 9, 2014
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Laxminarayan P, Kanathala S, Gangrade M, Kankan R, Ramachandra R. Novel crystalline polymorphic form of a camptothecin analogue. India Patent 255388, issued Feb 22, 2013. http://ipindiaservices.gov.in/patentsearch/GrantedSearch/ ReportProjectPopUp.aspx?Appl_No=1274%2fMUM%2f2005&Pbl_ No=1274%2fMUM%2f2005&Pat_No=255388 (accessed May 22, 2014). Anon. Pharma exports rise 10.50% to $14·6 bn in FY’13. The Hindu Business Line 5 June 2013. http://www.thehindubusinessline.com/ industry-and-economy/pharma-exports-rise-1050-to-146-bn-in-fy13/ article4784677.ece (accessed Jan 23, 2014). India—Parliamentary Standing Committee on Health and Family Welfare. Fifty-ninth report on the functioning of the central drugs standard control organisation. http://164.100.47.5/newcommittee/reports/ englishcommittees/committee%20on%20health%20and%20family%20 welfare/59.pdf (accessed Jan 23, 2014).
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United States Department of Justice. Generic drug manufacturer ranbaxy pleads guilty and agrees to pay $500 million to resolve false claims allegations, cGMP violations and false statements to the FDA. http://www. justice.gov/opa/pr/2013/May/13-civ-542.html (accessed Jan 23, 2014). Eban K. Dirty medicine. May 15, 2013. http://features.blogs.fortune.cnn. com/2013/05/15/ranbaxy-fraud-lipitor/ (accessed Jan 23, 2014). Eban K. The latest to claim fraud at generic Lipitor maker Ranbaxy: its owners. http://features.blogs.fortune.cnn.com/2013/05/23/ranbaxylipitor-fraud/ (accessed May 2, 2014).
We live in the Anthropocene era when humanity’s impact on both biological and geophysical systems is becoming increasingly dominant. Environmental trends, including large-scale changes to climate, water, and natural habitats, pose important challenges to sustaining the biosphere in a state conducive to the advancement of health and flourishing of humanity. Those challenges also threaten the very viability of human civilisation.1 The UN Intergovernmental Panel on Climate Change (IPCC) has assessed the risks to health from climate change, but much less has been written on the health effects of the other environmental changes or on the implications for health from interactions between different types of environmental stress. Biodiversity loss, freshwater withdrawals, cropland and pasture conversion, coastal buffer degradation, and ocean acidification have major implications for human health through effects on a range of health outcomes that include: water-related and vector-borne diseases; impacts of increased frequency and intensity of extreme events, such as floods, droughts, and heatwaves; and food security and undernutrition. Beyond these direct and ecologically mediated impacts, cultural and aesthetic deprivation, livelihood losses, population displacement, conflict, poverty, and ultimately collapse of our civilisation are of added concern. There is evidence, for example, that increased thermal stress will substantially reduce labour productivity in tropical and subtropical regions and earnings of subsistence farmers because of declining crop yields, thus increasing poverty.2 However, the nature and extent of many of these indirect pathways have yet to be successfully quantified. A major concern is the potential for many environmental stressors to influence agricultural productivity, freshwater provision and sanitation, biomass fuel www.thelancet.com Vol 384 August 9, 2014
burning and ambient air pollution, the incidence and distribution of climate sensitive diseases, and nutrient and waste absorption and detoxification. For example, a systematic review of more than 1000 studies concluded that “climate change is a threat to crop productivity in areas that are already food insecure”.3 Although increasing concentrations of carbon dioxide can stimulate growth in some crops, especially C3 crops such as wheat and rice, they can also adversely affect their nutritional quality. For example, a meta-analysis of 228 experimental studies showed decreases in protein content of 10–14% in edible portions of wheat, rice, barley, and potato, but decreases of only 1·5% in soybeans when they are grown in elevated atmospheric carbon dioxide.4 Recent evidence indicates that increasing concentrations of carbon dioxide in the atmosphere also lower the amount of micronutrients, notably iron and zinc, in the edible portions of food crops such as wheat, rice, and soybeans.5 About 2 billion people globally have deficiencies of these micronutrients and a large proportion of the human population depends on these types of food crops for much of their dietary intake. These changes are, therefore, likely to have substantial health and societal impacts. Intensive farming with large quantities of fertilisers, pesticides, and freshwater to offset these yield and nutritional declines can, in turn, cause serious offsite and downstream environmental damage. To assess the health effects of complex ecological alteration we need to better understand not only how changes in each system will affect health, but also how changes in different systems might interact over different timescales (both positively and negatively), and the extent to which adaptation (either spontaneous or planned) could reduce adverse effects on health. Improving our understanding of the complex linkages
Science Photo Library
Planetary health: a call for papers
To submit an abstract online go to http://ees.elsevier.com/ thelancet/default.asp
479
Comment
between human health and planetary health— the health of human civilisations—necessitates assessment of current and future health impacts of specific environmental changes and their interactions, while taking into account the varying vulnerability of populations and individuals. The Lancet–Rockefeller Foundation Commission on Planetary Health has been set up to assess the potential implications for health of multiple changes in the Earth’s “essential life support systems”,6 with the aim of publishing its assessment in mid-2015. The Commission has the opportunity to add value to previous initiatives, such as the Millennium Ecosystem Assessment, the IPCC, and other Lancet Commissions and Series by developing an interdisciplinary assessment of the complex interlinkages between environmental sustainability and health. However, it is essential to move beyond a restatement of the problems towards potential policy solutions, which can move humanity towards a more sustainable course within the finite, but uncertain, limits of exploitation of planetary resources and the capacity of ecosystems to absorb the wastes of the current world economy. Such an endeavour requires assessment of the scientific evidence on the risks to health and how to reduce them, with full recognition of the persistent gap between our unprecedented knowledge of diseases and the implementation of that knowledge, especially in developing countries.7 We also need to better understand the challenges to governance and current economic orthodoxy posed by inequitable and unsustainable patterns of development. Lessons from history about how communities, countries, and civilisations have addressed profound ecological change—or failed to do so—could have resonance for today. Innovative science is also needed to help decision makers because our scientific understanding of many of the complex interlinkages, contexts, and efficacy of solutions will remain imperfect, incomplete, and uncertain. We invite the submission of innovative and rigorous research that addresses the topic of global environmental change, ecosystem impairment, and the health of human civilisations. There will be a two-stage process for assessment of potential papers. The first stage involves the submission of a 300 word structured abstract outlining the objective, data sources, methods, and main conclusions of the study. This should be submitted by Oct 13, 2014, through The Lancet’s online submission 480
system referencing Lancet–Rockefeller Planetary Health. After a rapid triage process, selected researchers will be invited to submit full papers by Dec 23, 2014. These will be peer reviewed and those papers (an estimated two to four papers) that are deemed the most important and rigorous will be published alongside the Commission report. Defining appropriate case studies that can illustrate these challenges and how to address them will be essential to make the Commission’s report interesting and accessible to a wide audience. The Commission is, therefore, also interested to receive case reports of 350–700 words that illustrate one or more of the following: the impacts of, and vulnerability to, global environmental change; the effects of adaptation strategies to reduce impacts and promote resilient societies; the potential for health cobenefits of strategies to prevent environmental change in specific countries/communities. These case reports should be based on high-quality data that can be made available in the public domain and are derived from authenticated sources. The case studies will also be peer reviewed and may be published within the Lancet Commission report or in the web appendix accompanying the report. We aim to raise the profile of these issues within the research and wider global health community, as well as to stimulate collaborations between health, environmental, and other relevant disciplines to advance our understanding of both the threats and potential solutions to these pressing problems. Andy Haines, *Sarah Whitmee, Richard Horton Department of Social and Environmental Health Research and Department of Population Health, London School of Hygiene & Tropical Medicine, London, UK (AH); Centre for Biodiversity and Environment Research, Department of Genetics, Evolution and Environment, Division of Biosciences, University College London, London WC1E 6BT, UK (SW); and The Lancet, London, UK (RH) [email protected] We declare no competing interests. 1 2 3 4
5 6 7
Horton R. Offline: Reimagining the meaning of health. Lancet 2014; 384: 218. Dunne JP, Stouffer RJ, John JG. Reductions in labour capacity from heat stress under climate warming. Nature Climate Change 2013; 3: 563–66. Knox J, Hess T, Daccache A, Wheeler T. Climate change impacts on crop productivity in Africa and South Asia. Environ Res Lett 2012; 7: 034032. Taub DR, Miller B, Allen H. Effects of elevated CO2 on the protein concentration of food crops: a meta-analysis. Global Change Biol 2008; 14: 565–75. Myers SS, Zanobetti A, Kloog I, et al. Increasing CO2 threatens human nutrition. Nature 2014; 510: 139–42. Horton R, Beaglehole R, Bonita R, Raeburn J, McKee M, Wall S. From public to planetary health: a manifesto. Lancet 2014; 383: 847. Sanders D, Haines A. Implementation research is needed to achieve international health goals. PLoS Med 2006; 3: e186.
www.thelancet.com Vol 384 August 9, 2014