Intended for healthcare professionals


Planetary health: challenging power and privilege is key to a fairer and healthier future

BMJ 2024; 385 doi: (Published 15 April 2024) Cite this as: BMJ 2024;385:q853
  1. Sophie Gepp, research associate, Centre for Planetary Health Policy, Berlin,
  2. Melvine Anyango Otieno, , assistant lecturer, School of Environmental Sciences and Natural Resource Management, University of Eldoret, Kenya,
  3. Kent Buse, director, Healthier Societies Program, The George Institute for Global Health, Imperial College London, UK

As the 6th Planetary Health Annual Meeting begins in Kuala Lumpur, Sophie Gepp and colleagues commend progress in the field of planetary health but call for greater accountability of organisations to ensure planetary health justice

This year marks the 15th anniversary of the first publication of the framework of “planetary boundaries,” which describes the biophysical limits of Earth systems that, if breached, could have devastating consequences for humanity.1 Six years after this publication, the report of the Rockefeller-Lancet Commission on Planetary Health defined the concept as “the health of human civilisations and the natural systems on which they depend.”2 Though progress has been made in the field of planetary health, we need stronger commitment and action for justice and transformative change.

The field focuses on the interconnectedness of various Earth systems affected by human induced change and the link to health, the benefits of transdisciplinary approaches to understanding and tackling associated challenges, and the need for multi-sectoral policy responses.3 While the term “planetary health” is relatively new, a holistic vision of the connectedness of people and nature has been a part of Indigenous knowledge for millennia, which is now increasingly recognised after being overlooked and undermined for centuries.4

The emergence of this field and the movement to protect planetary health is taking place against the backdrop of rapid environmental degradation which imperils the health of people and the planet. The consequences of transgressing planetary boundaries, such as climate change and biodiversity loss, will continue to disproportionately affect marginalised communities and genders whose activities often contribute the least to climate change.567 It is estimated that climate change will push between 32 million and 132 million additional people into extreme poverty by 2030.8 Evidence, such as increases in gender based violence after extreme weather events9 and the threat of uninhabitability of some Small Island Developing States10 exemplifies how climate change worsens inequality.

As the latest Intergovernmental Panel on Climate Change report puts it: “Any further delay in concerted anticipatory global action on adaptation and mitigation will miss a brief and rapidly closing window of opportunity to secure a liveable and sustainable future for all.”11 Human activities have caused us to increasingly surpass planetary boundaries and move closer to a point where Earth’s systems are no longer able to self-regulate. It is therefore encouraging that the health community recognises this urgency and that we see an increasing number of individuals, networks, alliances, and organisations seeking to develop and scale up practical policies and interventions for a healthier and fairer future for us and the planet. We also see increasing attention in global agreements and discourse on planetary health, such as the recognition in 2021 of the “right to a healthy environment”12 and the first ever “health day” at COP28 in 2023.13

While this progress is commendable, much more needs to be done to secure the future of people and our planet. As the 6th Planetary Health Annual Meeting kicks off in Kuala Lumpur this week,14 a newly published report reveals that organisations active in planetary health have some way to go if they are to contribute in more equitable ways. The report looked at the organisations in the annual Global Health 50/50 survey, and found of the 197 sampled, 114 have planetary health related activities.15 Of the 99 non-profit organisations in the sample, only 24% showed evidence of tackling the root causes of gender inequity with gender transformative action in their planetary health activities. The report finds that only a fifth of the non-profit organisations reported gender disaggregated data. It also finds that some progress has been made with regards to gender parity in governance among the non-profit organisations, where 38% of chief executive officers or executive directors were women, but it found a strikingly low representation of people from low and middle income countries—less than 5% of board members were nationals of low income countries. Also absent is representation of people from geographies that are particularly affected by climate change, such as Small Island Developing States.

In light of these findings, we call for greater commitment and action for justice in planetary health work on three fronts. First, a greater emphasis on gender transformative approaches in planetary health research and programme implementation. Second, an increase in collection and reporting of disaggregated data, including gender and other variables of structural exclusion. And third, improving the diversity of leadership, including of the most affected groups and geographies.

Moving forward, the health community working on planetary health can learn from and join forces with organisations and movements working on climate and environmental justice. This can strengthen its arguments for and lend greater political support to its calls for transformative action, facilitate intersectoral approaches, and help ensure that the planetary health movement does not suffer from “tunnel vision” by missing important aspects of the intersection of climate change and health.16 A coordinated gender justice, health justice, and environmental justice movement that seeks to ensure the indivisible rights to equality, health, and a healthy environment will be more effective at dismantling systems that are harmful to planetary health than these movements working alone.

Nonetheless, the planetary health movement must critically reflect and act on power imbalances and privilege within its own community. Organisations working on planetary health must ensure that they do not perpetuate the same inequitable systems or replicate the structures of power and oppression that are driving the planetary crisis. Only by doing so will the planetary health movement meaningfully contribute to a just and healthy future.


  • Competing interests: KB declares that he is co-CEO of Global Health 50/50, a report of which is referenced in this Opinion. SG is a member of the Global Health 50/50 collective and a member of the board of directors of the Global Climate and Health Alliance. MAO is a member of the Planetary Health Alliance and a member of Climate-Health Africa Network for Collaboration and Engagement.

  • Provenance: not commissioned, not externally peer reviewed.