By including ‘a stable ecosystem and sustainable resources’ as a prerequisite for health, the Ottawa Charter became the first World Health Organization document to acknowledge sustainable development and what we would later call the ecological determinants of health. As the author of ‘Creating Environments for Health’, the ‘supportive environments’ theme paper for the 1986 Ottawa Charter conference, I am happy to say that getting these concepts into the list of prerequisites was one of my main contributions to the charter.
In my paper I focused on the physical environment “because the other major themes and workshops for the conference [were] concerned almost entirely with the social environment”. I particularly identified the global environmental challenges of pollution (understood broadly to include greenhouse gases) and resource depletion that “result from the worldwide impact upon our planetary ecosystem and resource base of population growth and intensive consumption in our industrialized societies”. I also touched on the need for a new economics of health, noting that “we can only create an economic environment that is promotive of health if we first have an economics that is conscious of health”.
From ecological determinants to planetary health
But although the WHO recognised in 2005 that natural ecosystems are “indispensable to the well-being and health of people everywhere”, it was not until 2015, with the release of a discussion paper on the ecological determinants of health published by the Canadian Public Health Association and the report of the Lancet Commission on Planetary Health that the role of the natural environment got the attention it deserved as the most fundamental determinant of health.
We now know there are planetary boundaries for nine vital Earth systems and we have crossed those boundaries for seven of them. Moreover, the trend for all seven of those systems is worsening. Disastrously, most of the world – and certainly the corporate and political elite – failed then and still fails dismally to understand the severity of the ecological challenges we face. As a result, we largely failed to act, and now we are in a much worse situation than was the case in 1986, although even then I noted “the solutions are known to us, and in many cases they have been tried and shown to be feasible”.
Building well-being societies
But in the Geneva Charter for Well-being we see for the first time a call for the achievement of health for all, not only now but also for future generations, while remaining within planetary boundaries. This is the logical extension of the Ottawa Charter’s recognition of ecosystem stability and resource sustainability. Our challenge is to create well-being societies everywhere. This will require a massive and rapid transformation in our political, economic and social systems to put well-being at the heart of governance.
I see six key needs:
First, we must recognise and protect the rights of nature, the rights of other species to exist and ecosystems to be considered living entities and thus persons, while making ecocide a crime against humanity and nature.
Second, we must recognise and protect the rights of future generations through legislation.
Third, we must implement a “drastic reduction in inequality of income, wealth and power” both between countries and within them as a “necessary condition for shared prosperity on a finite planet”.
Fourth, we must build healthy public policies for all the major societal systems – energy, food, built environments, transportation, extraction, consumption and waste management and much more – that drive these deeply troubling ecological and social changes.
Fifth, we must develop a well-being economy that ensures adequate prosperity for all and a stable steady state economyoperating within planetary boundaries.
Sixth, to enable and support all this, we must participate in an ongoing process of democratic engagement and society-wide conversation about the future we face and the future we want.
Perhaps most important of all, we need to transform the underlying societal and political values that are driving our modern societies to the brink. It has always been the case that health is a political choice. Do we choose the path of ecological sustainability, economic sufficiency and stability, social and economic justice and well-being, or the path of endless growth in consumption, ecological decline and collapse, rising inequality and deteriorating health? It should not be a difficult choice!
