Turning the Bus: Why Global Health Needs a Planetary Health Strategy

The New York Times published two seemingly unrelated articles within a month of each other in 2024. The first reported that in agricultural counties where white-nose disease had extinguished bat populations, U.S. farmers responded with a 31% increase in pesticide use. Apparently associated with the increased chemical exposure, infant mortality in those counties rose by 8%. The second reported that mortality from hurricanes in the U.S. from 1930 to 2015 was roughly 400 times greater than previously understood. When assessing mortality over several years after a hurricane, researchers Rachel Young and Solomon Hsiang found that the storms resulted in 3.6–5.7 million deaths—about 4% of all-cause mortality in the continental U.S., according to their 2024 Nature article. 

What the Times failed to understand was that articles like these are pieces of a much larger narrative: the story of planetary health. For those of us committed to advancing global health, it’s time to pay attention to—and participate in—this young, transdisciplinary field.

Planetary health has emerged over the past 10 years from a recognition that Earth’s natural systems play a critical role in supporting human health, and the degradation of those systems—climate change, biodiversity loss, pollution, marine destruction—is becoming a dominant driver of global burden of disease. Humanity’s ecological footprint exceeds our planet’s capacity to absorb the wastes we are producing or provide the resources that we are using. As a result, we are destabilizing the Earth system and degrading the foundational conditions for human health and well-being—the air we breathe, the water we drink, and the quality and quantity of food we can produce.

The Earth crisis is now driving a global health and humanitarian crisis. For medical and public health practitioners and researchers, this means we must change how we do our jobs: We cannot safeguard human health into the future while the natural life support systems that we all depend upon crumble under the weight of our collective ecological footprint. It is as though we packed our children into a bus that is headed toward the edge of a chasm and the driver is asleep at the wheel. The course we are on as a global society is inconsistent with a livable future for humanity. As global health professionals, it’s our job to wake up the bus driver and turn the bus around.

What would that look like? It requires us to redefine what it means to be medical or public health practitioners and researchers. We need to break out of our silos and focus on a different suite of innovations, policies, and practices to protect the public’s health. This means partnering with urban planners, policymakers, business leaders, material scientists, and others. Transforming the systems we’ve built to meet our needs—energy, food, manufacturing, built environment—to protect and regenerate our natural life support systems will take a whole-of-society approach.  

Last month, my colleagues and I published a study in Nature showing the foundational role of wild pollinators like honeybees and bumblebees in supporting nutrition and human health. By tracking over 10,000 visits between pollinators and crops, and biweekly dietary recall surveys among 400 villagers in 10 villages over a year, our team of entomologists, agricultural scientists, biologists, and nutritional epidemiologists found that wild pollinators contributed 44% of people’s farming income and more than 20% of their intake of vitamin A, folate, and vitamin E. This work follows on a global study we published in The Lancet documenting nearly half a million excess deaths annually worldwide because of insufficient wild pollinators to optimize the production of foods like fruits, vegetables, and nuts that protect us from heart disease, stroke, diabetes, and certain cancers. Our multidisciplinary team demonstrated that supporting nutritional health must go beyond fortifying foods, offering supplements, or encouraging dietary diversity: It requires pollinator-friendly practices like creating forage and habitat, and reducing use of pesticides.

Those of us who do not work directly in planetary health topics can still address the ecological determinants of health. Nurses and physicians are the most trusted messengers in the U.S., and we can communicate with our patients about the importance of these shifts in how we live. Many of these shifts—like adopting a planetary health diet (high in plants and low in meat and dairy), designing cities with green spaces and access for pedestrians and bicycles, demanding renewable energy options, and spending time in nature—have strong health benefits. We can advocate that our professional societies articulate the urgency of stabilizing the Earth system to secure our health, and we can partner with local organizations, including mothers, faith leaders, youth, and others to demand action at local, regional, and national scales. We also can ensure that planetary health is integrated into the curriculum of our public health, nursing, and medical schools and learn how to integrate ecological determinants of health into our own teaching.

These actions are just a few of the ways those of us working in global health and medicine can adapt our efforts to reflect the fact that the health of humanity and the state of the planet are inextricably connected.

At the end of the day, it is up to all of us to wake the bus driver—and turn things around.

Samuel Myers, MD, MPH, is faculty director of the Planetary Health Alliance and the Johns Hopkins Institute for Planetary Health and a professor in Environmental Health and Engineering at the Johns Hopkins Bloomberg School of Public Health.

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