Planetary Health Watch: integrated monitoring in the Anthropocene epoch

摘要

Impressive progress in human development has been accompanied by profound shifts in a range of the Earth's natural systems, including climate change, ocean acidification, biodiversity loss, land use change, pollution, and freshwater depletion.1Millennium Ecosystem AssessmentEcosystems and human well-being: synthesis. Island Press, Washington, DC2005Google Scholar, 2Whitmee S Haines A Beyrer C et al.Safeguarding human health in the Anthropocene epoch: report of The Rockefeller Foundation–Lancet Commission on planetary health.Lancet. 2015; 386: 1973-2028Summary Full Text Full Text PDF PubMed Scopus (1125) Google Scholar These pervasive and interconnected changes are primarily driven by a growing—although inequitably distributed—demand for energy, food, and other resources, and will accelerate in future in the absence of decisive action. These planetary scale shifts, which characterise the Anthropocene epoch,3Steffen W Persson Å Deutsch L et al.The Anthropocene: from global change to planetary stewardship.Ambio. 2011; 40: 739-761Crossref PubMed Scopus (914) Google Scholar pose major but imperfectly understood threats to humanity (and to life more generally). Through a range of pathways, the shifts can have direct, ecosystem mediated or indirect (often deferred or displaced) effects on health, the latter mediated in general through social systems.1Millennium Ecosystem AssessmentEcosystems and human well-being: synthesis. Island Press, Washington, DC2005Google Scholar, 3Steffen W Persson Å Deutsch L et al.The Anthropocene: from global change to planetary stewardship.Ambio. 2011; 40: 739-761Crossref PubMed Scopus (914) Google Scholar To determine how environmental changes, singly or in concert, affect health, a monitoring and forecasting system is needed to link human health and environmental indicators in time and space, and to assess and predict trends. Such a Planetary Health Watch could improve the effectiveness of adaptation and mitigation strategies, assess progress towards nationally and internationally agreed targets, act as an early warning system, and hold decision makers accountable. Indicators for inclusion in the system should be prioritised using transparent criteria, including relevance, sensitivity, sustainability, scalability, accuracy, economic viability, and consistency.4Hambling T Weinstein P Slaney D et al.A review of frameworks for developing environmental health indicators for climate change and health.Int J Environ Res Public Health. 2011; 8: 2854Crossref PubMed Google Scholar A number of initiatives already monitor different aspects of the planetary health agenda, but they typically address the effects of single environmental states and exposures (eg, climate change5Watts N Amann M Ayeb-Karlsson S et al.The Lancet Countdown on health and climate change: from 25 years of inaction to a global transformation for public health.Lancet. 2018; 391: 581-630Summary Full Text Full Text PDF PubMed Scopus (584) Google Scholar or pollution6Landrigan PJ Fuller R Acosta NJR et al.The Lancet Commission on pollution and health.Lancet. 2018; 391: 462-512Summary Full Text Full Text PDF PubMed Scopus (1963) Google Scholar), which makes it difficult to attribute changes in health outcomes to specific exposures. To monitor potential confounding factors (including socioeconomic and health-care trends), integrated monitoring of the three dimensions of sustainable development—social, economic, and environmental—is necessary. Human populations exhibit different levels of vulnerability to environmental change, which means that information on exposures alone may inadequately predict health outcomes. One example is the effect of heat stress, which can vary depending on age and physical activity patterns of exposed populations, as well as their access to technology (eg, air conditioning). Similarly, natural systems exhibit different levels of vulnerability to human pressures and respond in non-linear ways, resulting in tipping points (eg