Intended for healthcare professionals


Monitoring progress towards planetary health

BMJ 2017; 359 doi: (Published 07 December 2017) Cite this as: BMJ 2017;359:j5279
  1. Rishma Maini, public health registrar in global disaster risk reduction1,
  2. Ronald Law, chief of preparedness2,
  3. Francisco Duque III, secretary of health2,
  4. Gloria Balboa, director3,
  5. Hiroyuki Noda, director of office for AIDS control4,
  6. Sachiko Nakamura, technical official4,
  7. Virginia Murray, public health consultant in global disaster risk reduction1
  1. 1Public Health England, London, UK
  2. 2Philippine Department of Health, Manila, Philippines
  3. 3Health Emergency Management Bureau, Philippine Department of Health, Manila, Philippines
  4. 4Tuberculosis and Infectious Diseases Control Division, Ministry of Health, Labour, and Welfare Government of Japan, Tokyo, Japan
  1. Corresponding author: Virginia.Murray{at}

International agreements must include appropriate indicators, published regularly

Tackling the interlinked global challenges of disaster risk, sustainable development, and climate change requires urgent and transformative action if we want to protect current and future generations. Rising sea levels and warmer oceans have intensified the destruction caused by storms, and an estimated 90% of major disasters caused by natural hazards recorded between 1995 and 2015 were linked to climate and weather.1 Increasingly harmful environmental trends are driven mainly by human activity, and full engagement with the emergent discipline of planetary health will be crucial to protect populations worldwide. This discipline seeks “the achievement of the highest attainable standard of health, wellbeing, and equity worldwide through judicious attention to the human systems—political, economic, and social—that shape the future of humanity, and the Earth’s natural systems that define the safe environmental limits within which humanity can flourish.”2

Achieving planetary health requires comprehensive international collaboration and agreement at the highest level. The synchronous adoption of several landmark UN agreements in 2015 represents a step in the right direction. The Paris Agreement aims to legally bind countries to hold the increase in global average temperature to below 2°C above pre-industrial levels.3 The sustainable development goals (SDGs) encompass the “universal call to action to end poverty, protect the planet from climate change, and ensure that all people enjoy peace and prosperity,”4 and the Sendai Framework for Disaster Risk Reduction 2015-30 promotes shifting the focus from managing disasters when they happen to managing the risk of disaster proactively.5 For example, in improving our understanding of disaster risk and its dimensions of exposure, vulnerability, and hazard characteristics, we may be able to prevent and reduce the impact of future disasters.

Indicators of progress

One way of catalysing change and ensuring commitment to these international agreements is to ask countries to publish results achieved against relevant indicators of progress. For example, the Sendai Framework has recently agreed a set of 38 indicators and is in the process of developing technical guidance to help reporting at country level. The Lancet Countdown Report has also recently published results on indicators of climate change and the effects on health, and will continue to review progress against these indicators annually6; it has highlighted the need to act urgently as environmental changes are having damaging effects on health worldwide. In addition, The Rockefeller Foundation-Lancet Commission on Planetary Health recognises the importance of exploring synergies and connections between the SDGs and planetary health; for example, relevant indicators to include the effectiveness of national policies to increase resilience to environmental change.2

Countries such as Japan, the Philippines, and the UK welcome the introduction of indicators for monitoring and evaluating actions taken to limit the consequences of climate change, reduce disaster risk, and thereby improve planetary health. Japan’s government has long acknowledged the risks it faces from climate change and related natural disasters, having hosted the predecessor of the Paris Agreement,3 the Kyoto Protocol,7 and the Sendai Framework.5 The Philippines is one of the top five countries in the world most vulnerable to climate change: in November 2013, typhoon Haiyan left a trail of devastation across its islands, claiming the lives of more than 6000 people, with government estimates of total damage and losses totalling $12.9bn (£9.9bn; €11bn).8 In 2016 it was one of three countries to pilot test the Sendai Framework’s targets and indicators,9 determining the feasibility of measurement and identifying activities to tackle reporting gaps. In the UK, Public Health England has recently published a review of how its activities and projects are meeting the targets and goals of the Sendai Framework.10

The benchmarking of countries’ performance against indicators linked to global agreements is a powerful way to engage governments and mobilise resources—no country wants to fall behind. Actions taken to increase the adaptive capacities and resilience of countries to climate change and related weather disasters will ultimately benefit us all and help to achieve planetary health.


  • Competing interests: The authors have read and understood BMJ’s policy on declaration of interests and have no relevant interests to declare.

  • Provenance: Not commissioned, not peer reviewed.


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