Planetary health underpins an economy of wellbeing

I was both excited and disappointed to read Cylus and Smith’s article on the economy of wellbeing:1 excited to see that The BMJ had commissioned an article about centring the economy on wellbeing rather than an arbitrary measure such as gross domestic product, but disappointed that the article failed to consider the foremost determinant of human wellbeing—planetary health.

Despite being widely reported as a crisis—and considered by the World Health Organization to be the greatest threat to human health in the 21st century2—Cylus and Smith’s article does not consider the ecological crisis in terms of how we should devise an economy of wellbeing.

Human wellbeing is connected to and dependent on planetary life support systems that provide us with the fundamental determinants of health—clean air, fresh water, and conditions that enable us to grow and harvest food—as well as preventing disease through healthy ecosystems.

Economists have given this thought. In Doughnut Economics: How to Think Like a 21st Century Economist, Kate Raworth describes an economic model that allows for human flourishing.3 The inner ring of the “doughnut” represents human rights to a standard below which no one should fall—access to food, water, education, healthcare, social equity, peace, political voice, and so on. The outer ring represents the ecological ceilings of planetary boundaries—such as air pollution, biodiversity loss, ocean acidification, and fresh water withdrawals. In between these two rings is what she calls the “safe and just space for humanity.”

It is important that as we build back our economy from the covid-19 crisis we put human wellbeing at the centre of our decision making. To do this requires a clear understanding of health determinants, the most fundamental of which depend on planetary health.