Safeguarding human health in the Anthropocene epoch: report of The Rockefeller Foundation–Lancet Commission on planetary health

protection of health in the near and long term.Several essential steps need to be taken to transform the economy to support planetary health.These steps include a reduction of waste through the creation of products that are more durable and require less energy and materials to manufacture than those often produced at present; the incentivisation of recycling, reuse, and repair; and the substitution of hazardous materials with safer alternatives.Despite present limitations, the Sustainable Development Goals provide a great opportunity to integrate health and sustainability through the judicious selection of relevant indicators relevant to human wellbeing, the enabling infrastructure for development, and the supporting natural systems, together with the need for strong governance.The landscape, ecosystems, and the biodiversity they contain can be managed to protect natural systems, and indirectly, reduce human disease risk.Intact and restored ecosystems can contribute to resilience (see panel 1 for glossary of terms used in this report), for example, through improved coastal protection (eg, through wave attenuation) and the ability of fl oodplains and greening of river catchments to protect from river fl ooding events by diverting and holding excess water.The growth in urban populations emphasises the importance of policies to improve health and the urban environment, such as through reduced air pollution, increased physical activity, provision of green space, and urban planning to prevent sprawl and decrease the magnitude of urban heat islands.Transdisciplinary research activities and capacity need substantial and urgent expansion.Present research limitations should not delay action.In situations where technology and knowledge can deliver win-win solutions and co-benefi ts, rapid scale-up can be achieved if researchers move ahead and assess the implementation of potential solutions.Recent scientifi c investments towards understanding non-linear state shifts in ecosystems are very important, but in the absence of improved understanding and predictability of such changes, eff orts to improve resilience for human health and adaptation strategies remain a priority.The creation of integrated surveillance systems that collect rigorous health, socioeconomic, and environmental data for defi ned populations over long time periods can provide early detection of emerging disease outbreaks or changes in nutrition and non-communicable disease burden.The improvement of risk communication to policy makers and the public and the support of policy makers to make evidence-informed decisions can be helped by an increased capacity to do systematic reviews and the provision of rigorous policy briefs.Health professionals have an essential role in the achievement of planetary health: working across sectors to integrate policies that advance health and environmental sustainability, tackling health inequities, reducing the environmental impacts of health systems, and increasing the resilience of health systems and populations to environmental change.Humanity can be stewarded successfully through the 21st century by addressing the unacceptable inequities in health and wealth within the environmental limits of the Earth, but this will require the generation of new knowledge, implementation of wise policies, decisive action, and inspirational leadership. Key messages1 The concept of planetary health is based on the understanding that human health and human civilisation depend on fl ourishing natural systems and the wise stewardship of those natural systems.However, natural systems are being degraded to an extent unprecedented in human history. 2 Environmental threats to human health and human civilisation will be characterised by surprise and uncertainty.Our societies face clear and potent dangers that require urgent and transformative actions to protect present and future generations.3 The present systems of governance and organisation of human knowledge are inadequate to address the threats to planetary health.We call for improved governance to aid the integration of social, economic, and environmental policies and for the creation, synthesis, and application of interdisciplinary knowledge to strengthen planetary health.4 Solutions lie within reach and should be based on the redefi nition of prosperity to focus on the enhancement of quality of life and delivery of improved health for all, together with respect for the integrity of natural systems.This endeavour will necessitate that societies address the drivers of environmental change by promoting sustainable and equitable patterns of consumption, reducing population growth, and harnessing the power of technology for change.