challenges Communication Planetary Health Ethics: Beyond First Principles Alexander Foster 1,* , Jennifer Cole 2,* , Andrew Farlow 3 and Ivica Petrikova 4 1 School of Anthropology and Museum Ethnography, Oxford University, Oxford OX2 6PE, UK 2 Department of Geography, Royal Holloway University of London, Egham TW20 0EX, UK 3 Oxford Martin School, Oxford University, Oxford OX1 3BD, UK; [email protected] 4 Department of Politics and International Relations, Royal Holloway University of London, Egham TW20 0EX, UK; [email protected] * Correspondence: [email protected] (A.F.); [email protected] (J.C.); Tel.: +44-7815-530-951 (A.F.); +44-7847-756-474 (J.C.) Received: 6 December 2018; Accepted: 12 February 2019; Published: 15 February 2019 Abstract: Planetary health is a transdisciplinary approach that aims to advance the understanding of the links between human-driven changes to the planet and their consequences, and to develop appropriate solutions to the challenges identified. This emerging movement has not yet agreed upon a code of ethics to underpin the rapidly expanding body of research being carried out in its name. However, a code of ethics might support the principles for planetary health set out in the Canmore Declaration of 2018. Phrases such as “Public Health 2.0”, “Human Health in an Era of Global Environmental Change”, or “A safe and just operating space for humanity” are often used in planetary health discussions, but are not always clearly defined and so far, the field lacks a strong guiding ethical framework. In this paper, we propose a starting point towards a code of ethics for planetary health that builds on the Canmore Declaration. We chose to propose 12 ethical principles in recognition of the need for a 12-Step Programme for the planet. The human race must identify and reject damaging behaviours. Evidence of the harm we are causing the planet is no longer enough and refraining from certain current practices is essential for Earth’s future health. We must motivate advocacy and calls for action. We believe a shared ethical code can act as a tool to enable and encourage that process. This paper is presented to the planetary health community as a starting point, not as a finished agenda. We welcome comments, critiques, additions and the opportunity to rework our approach accordingly. Keywords: planetary health; ethics; principles 1. Introduction Planetary health is a transdisciplinary approach that aims to advance the understanding of the links between human-driven changes to the planet and their consequences [1], and to develop appropriate solutions to the challenges identified [2]. However, it does not yet have an ethical code that can act as an agreed base against which identified solutions can be evaluated. The aim of this paper is to propose a starting point for planetary health ethics, building on the Statement of Principles set out in the Canmore Declaration of 2018 [3], which itself builds upon the 1986 Ottawa Charter for Health Promotion [4]. Both affirm the urgent need to consider the health of people, places and the planet as indistinguishable. We propose 12 ethical principles that might act as a roadmap towards the admirable goals inherent in the existing principles, though what we set out here is a work in progress and it is not intended to represent a finished product. We seek input and collaboration from the wider academic and non-academic community to critique, refine and amend our approach in order to ensure the ethical underpinning we suggest is collaboratively agreed upon and mutually acceptable to all stakeholders. Challenges 2019, 10, 14; doi:10.3390/challe10010014 www.mdpi.com/journal/challenges Challenges 2019, 10, 14 2 of 8 At the heart of our reasoning for why such an ethical underpinning is required is the subtle difference between “principles” and “ethics”. Principles are aspirational [5], but also generally abstract. Ethics are more practical and tangible. They are standards that can be adhered to (or violated), and they guide the choices that we make in our daily lives, such as, should I drive a car that emits greenhouse gases when I could walk? Or, should I spend money on entertaining myself when I could give that money to the poor [6]? Such decisions inevitably require us to choose one course of action and its consequences, over another course of action with different consequences. Ethics do not provide incontrovertible answers. They can be highly controversial and politically loaded, and finding consensus on what they should be will not be easy, particularly in a pluralistic world [7]. However, they do provide a base for ethical reasoning, from which principles can be put into practice. They can, therefore, provide a basis for negotiating actions in situations where decisions on whether or not to act, and how to act, is neither unanimous nor the preferred first choice of all actors [7]. In this sense, the notion of ethics carries with it something bigger than the sense of the individual, pushing us towards actions that are not (only) for self-interest [6]. Ethical judgements thus empower us to transcend our own likes and dislikes and to reason with others as to why they should do the same. Inherent in traditional ethics are concepts such as honesty, prudence, avoiding harm and concern for others [7]. If we can extend the notion of “others” to other species inhabiting the Earth and to the Earth itself, we can more easily ensure the “sustainable vitality of all systems” called for by the Canmore Declaration [3]. Ethics thus provide the foundation on which a principled framework for building a holistically healthier world can rest. For example, Colin Butler [8] has proposed updating existing ideas of epidemiology to the Anthropocene’s “population of unprecedented size and connectedness”, using the Canmore Declaration principles to encourage the embrace of spiritual thinking, concepts such as deep time [9] and indigenous philosophies. Human ingenuity should be able to better steward our natural resources; we suggest that the addition of an ethical code can help operationalize the principles on which we need to act in pursuit of that stewardship. In drafting this ethical code, our foundation was the concept of Planetary Health as it was discussed in 2013, at the centennial gathering of the Rockefeller Foundation [10]. The gathering discussed the consequences of climate change and the impact of human activity on the environment, in particular, the future consequences of such actions. The notion that human health is intrinsically connected with the health of the planet is not new [11], and has been a firm part of traditional, indigenous knowledge in many parts of the world for decades. However, in contemporary discourse the concept re-emerged during the environmental movements of the 1970s [3]. In 1980 the environmental group, Friends of the Earth, attempted to expand the World Health Organization’s definition of health to, “health is a state of complete physical, mental, social and ecological well-being and not merely the absence of disease— [ ... ] personal health involves planetary health”. Since that time, Planetary Health has become a unifying term in a growing movement that has focused on environmental sustainability and the impact of environmental degradation on human health. Its literature has demonstrated a strong focus on both practical application and ideological and academic study [12]. Active planetary health research programmes and networks are now supported by the Rockefeller Foundation Economic Council on Planetary Health based at the University of Oxford, UK [13], the Wellcome Trust [14], the Worldwide Universities Network (WUN) [15], and the Planetary Health Alliance, an international network of more than 70 research organizations [16]. A monthly peer-reviewed journal, Lancet Planetary Health [17] is entering its third year of publication. A growing number of universities are badging undergraduate and postgraduate courses to the field and running dedicated planetary health programmes. 2. Capturing the Zeitgeist: Opportunities and Threats We must be mindful, however, of guarding against the movement slipping into a new form of eco-environmentalism and ensure that the language used remains attractive to policymakers, the business sector and economists, as well as ensuring it does not become a label by which products Challenges 2019, 10, 14 3 of 8 or practices can claim to be more environmentally friendly than they are. Planetary health discussions have become peppered with a series of phrases that seek to capture the zeitgeist of the approach but do not always contain much substance. “Public Health 2.0” [10] seeks to identify the key actions for the 21st century that will have a comparable impact to that of sanitation since the 19th century (and we should not forget that we have yet to achieve universally improved sanitation for all) [18]. “Human Health in an Era of Global Environmental Change” [19] considers the different trajectories of environmental change, such as urbanization, agricultural intensification, climate change and the increasing pollution of air, land and oceans as the vectors of human ill-health. Finally, “A safe and just operating space for humanity” [20] emphasizes the need to ensure that the development of developing countries is not held back by the developed world’s need to conserve limited (ecological) resources for its own use. Exactly how concepts such as social equity and justice, responsible and sustainable development, and achievement of high standards of living for all can be made to fit together is not yet well defined. Furthermore, the notion that the UN’s Sustainable Development Goals can be achieved without unacceptable damage being inflicted on the Earth’s ecosystems is being increasingly challenged [21], as is the possibility that the global average lifespan may have reached a peak from which it is now declining [22].