How to achieve a ‘health renaissance’

Health and the environment have often been seen as costs on ‘the economy’. The pandemic has shown they are its foundations.

On May 21st the Italian presidency of the G20 and the European Commission will co-host the Global Health Summit in Rome. A few days afterwards, the World Health Organization will hold its World Health Assembly.

Obviously, both events are dedicated to imagining and fostering better health policies in the face of the Covid-19 tragedy. ‘The world needs a new beginning on health policy. And our health renaissance begins in Rome,’ declared the commission president, Ursula von der Leyen, on May 6th. We share this hope.

As members of civil society, we have been called upon to share our insights with the summit participants who will be drafting the ‘Rome Declaration’. Today we are publishing a new paper (and an encapsulating video) which sets out six principles for the much-needed design and dissemination of a health-environment policy at all governance levels.

Fruitful interdependencies

Our proposals are bold but, as illustrated by case studies from around the world in our paper, they are also entirely within reach. In essence, we call upon delegates at these two crucial summits to recognise and act upon the fruitful interdependencies among health, the environment and the economy, embodied in the following principles.

First and foremost, recognise the health-environment nexus as the core of planetary health and evolve from cost-benefit analysis to recognition of ‘co-benefits’. As the world strives to navigate global environmental and health crises, much of our failure to respond effectively to both comes from the perceived costs the actions required would have on ‘the economy’. This is however ultimately just a phrase connoting how we produce and provide for one another. Transition of our economic system away from self-destruction certainly carries cost but it is visibly lower than the cost of non-transition.

We must build a system which does not recognise a trade-off between ‘saving the economy’ and ‘saving lives’, nor between ‘the economy’ and ‘the environment’. If we degrade our environment, we destroy our health and the foundations of all economic activity. The real trade-off is between the joint preservation of these three valuable dimensions of human existence or all three degrading into irreparable loss.

Therefore, it’s time to move beyond the cost-benefit approach, which continues to dominate our collective actions and decision-making. What we need is a ‘co-beneficial’ approach, which recognises the intrinsic value of the health of our people and planet and their role as the platform for economic activity. We then realise that mitigating climate change is not only vital for our collective health and wellbeing but also brings considerable social savings from improved health.

Prioritise in healthcare prevention and mitigation. The pandemic has shown that healthcare is a vital organ of our society. But it has also brought to the surface the benefit, for our economy as well as our health, of a focus on prevention. The healthcare sector should be at the forefront here—including ‘preventing’ health and environmental damages due to its own practice. Investing in prevention would have a co-benefits effect in reducing the number of ill people, environmental damage and public spending, positively affecting all the three valuable dimensions: health, environment and the economy.

We must also mitigate what cannot be prevented. Covid-19 gave us a clear illustration of how having, or not having, a plan to deal with a healthcare emergency could affect our lives. We also came to understand how important it is to have the public on board in such situations. So for prevention and mitigation to work, advancing the health literacy of citizens must be part of the package.

Rethink food production and consumption. In all our daily lives, food indicates most strikingly the merits of a co-benefits approach. Global food systems are detrimental to interconnected human and planet health but several wellbeing opportunities are within reach. Foods known to be associated with improved human health have among the lowest environmental impacts, while resource-intensive foods are often associated with the largest increases in disease risk.

Healthier dietary choices can bring about further health-environment co-benefits, such as substantially lowering the costs incurred by healthcare systems to deal with non-communicable diseases or the non-healthcare costs of decreased labour productivity and tax revenues. Additional co-benefits could be achieved by tackling the widespread wastage of food at both the production (primarily in low- and middle-income countries) and consumption (in high-income countries) stages. Better programmes to cut food losses and redistribute food to vulnerable groups would simultaneously reduce environmental impacts and meet urgent human need.

Develop wellbeing energy systems. The current global energy system does not make sense from a wellbeing point of view. Air pollution resulting from the use of fossil fuels is playing a key role in the health vulnerability of Europeans facing Covid-19, while mitigating air pollution in European cities would bring a key health co-benefit—reducing the risk of co-morbidity in the face of multiple ecological shocks, such as respiratory diseases but also heatwaves, which are becoming more frequent and intense on the continent.

The shift towards strategies of global and national energy transition, linking health, employment, sustainability and safety co-benefits, offers compelling and robust evidence of short- and long-term gains. When all health co-benefits are taken into account—chief among them morbidity and mortality related to air pollution (recent studies suggest these are much higher than previously estimated)—the transition to renewable energies leads to saving 15 times the cost of their deployment.

Invest in social co-operation. Social co-operation is the main source of human prosperity and the key to sustainability. Yet current economic systems tend to increase social inequality as well as social isolation, harming human wellbeing today and in the future. Investments in social co-operation are intrinsically linked to shared human and planetary wellbeing, with many co-benefits for both people and planet. There is growing evidence of a sustainability-justice nexus: it makes environmental sense to mitigate our social crisis (by reducing inequality and isolation) and social sense to mitigate our environmental crises (by reducing human pressure on ecosystems).

Harness education for wellbeing. Education and health have been found over and over again to correlate with each other. People with more years of schooling generally have better health, while ill-health (as with poor nutrition) tends to hinder school performance and learning.

In our paper, however, we call for reflection on the type of education we really need. Current western education has focused on preparing people for the job market, yet education should be much more than that: it should be about critical thinking. It should provide the platform to acquire knowledge as well as questioning how, even if—for the good of the entire society—that knowledge should be used.

The connection with our environment has also been lost within the current form of education. Many of today’s western students see nature through books or outside their windows, while valuable local knowledge has been wiped out. Even universities follow the mantras of classical economic theory, with few alternatives taught to students and research driven by the goal of production rather than long-term solutions. Young people are already questioning our education system and asking for something better, which it is time to provide.

A more solid foundation

These principles do not cover all the areas where health, the environment and the economy intertwine. They do however provide a good foundation upon which to build policies that aim for healthy people on a healthy planet.

As we approach the Rome summit and the WHO assembly, we would challenge participants with two questions. What if the best economic policy is a strong health policy? And what if the best health policy is a strong environmental policy?

As European countries know, crises are cradles for new visions, catalysts for new approaches to gain momentum. Rome may not have been built in a day, but the health-environment co-benefits approach can help frame Europe’s reconstruction.