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Far-reaching changes to the structure and function of the Earth's natural systems represent a growing threat to human health. And yet, global health has mainly improved as these changes have gathered pace. What is the explanation? As a Commission, we are deeply concerned that the explanation is straightforward and sobering: we have been mortgaging the health of future generations to realise economic and development gains in the present.

Human activity is rapidly transforming most of Earth’s natural systems. How this transformation is impacting human health, whose health is at greatest risk, and the magnitude of the associated disease burden are relatively new subjects within the field of environmental health. We discuss what is known about the human health implications of changes in the structure and function of natural systems and propose that these changes are affecting human health in a variety of important ways. We identify several gaps and limitations in the research that has been done to date and propose a more systematic and comprehensive approach to applied research in this field. Such efforts could lead to a more robust understanding of the human health impacts of accelerating environmental change and inform decision making in the land-use planning, environmental conservation, and public health policy realms.

Canine distemper virus (CDV) has recently emerged as an extinction threat for the endangered Amur tiger (Panthera tigris altaica). CDV is vaccine-preventable, and control strategies could require vaccination of domestic dogs and/or wildlife populations. However, vaccination of endangered wildlife remains controversial, which has led to a focus on interventions in domestic dogs, often assumed to be the source of infection. Effective decision making requires an understanding of the true reservoir dynamics, which poses substantial challenges in remote areas with diverse host communities. We carried out serological, demographic, and phylogenetic studies of dog and wildlife populations in the Russian Far East to show that a number of wildlife species are more important than dogs, both in maintaining CDV and as sources of infection for tigers. Critically, therefore, because CDV circulates among multiple wildlife sources, dog vaccination alone would not be effective at protecting tigers. We show, however, that low-coverage vaccination of tigers themselves is feasible and would produce substantive reductions in extinction risks. Vaccination of endangered wildlife provides a valuable component of conservation strategies for endangered species.

Habitat connectivity in southern Africa's Kavango Zambezi Transfrontier Conservation Area (KAZA TFCA, or KAZA) is hindered by the presence of veterinary fences put in place to prevent transboundary animal disease transmission. In northern Botswana's Ngamiland, much of the fencing infrastructure is in disrepair due to ineffective maintenance in the face of increased elephant damage, but specific sections of some fences still restrict critical wildlife movements. We undertook qualitative risk assessments for sections of the Northern Buffalo fence near the Okavango Delta and the Zambezi Border and Western Border fences along the Botswana-Namibia borders. We assessed multiple risk pathways for three main transboundary animal diseases (foot and mouth disease, contagious bovine pleuropneumonia and peste des petits ruminants) under three different scenarios: (1) the status quo (fences as they currently are), (2) with hypothetical removal of specific fence sections, and (3) with hypothetical removal of fence sections with risk mitigation measures instituted. Our study found that hypothetical removal of these fence sections did not increase the risk of the transboundary animal diseases of interest, and that with the institution of specific risk mitigation measures (such as strategic livestock herding), the overall risk of some diseases would be lower compared to the status quo. Each pathway contained critical steps with low, very low or negligible risk which influenced the overall risk for the pathway. Based on low estimated risks, sections of all three fences could be considered for removal, but further information was needed for the Western Border fence. Key stakeholders established consensus to move forward with consultations with local communities and to offer assistance with the implementation of risk mitigation measures (such as improved herding, kraaling) conditionally associated with potential removal of key fence sections. Opening the fences in key low-risk areas would restore connectivity for elephants and other wildlife and potentially reduce human-wildlife conflict in areas where high densities of elephants are constrained by fences. This new, more sectorally integrative approach to livestock disease control is vital to wildlife's ability to access key resources over space and time and thus to the sustained success of KAZA.

Concern has been spreading across scientific disciplines that the pervasive human transformation of Earth's natural systems is an urgent threat to human health. The simultaneous emergence of “GeoHealth” and “Planetary Health” signals recognition that developing a new relationship between humanity and our natural systems is becoming an urgent global health priority—if we are to prevent a backsliding from the past century's great public health gains. Achieving meaningful progress will require collaboration across a broad swath of scientific disciplines as well as with policy makers, natural resource managers, members of faith communities, and movement builders around the world in order to build a rigorous evidence base of scientific understanding as the foundation for more robust policy and resource management decisions that incorporate both environmental and human health outcomes. Key Points Global environmental change is an urgent threat to human health Action‐focused, transdisciplinary research to optimize the health of people and ecosystems is needed The emerging field of Planetary Health/GeoHealth aims to build a scientific evidence base to support more robust policy decisions

Since the publication of the Rockefeller-Lancet Commission Report on Planetary Health,1 interest in planetary health has grown. There are many research themes captured within planetary health, including the effects of climate change on human health; environmental change and food systems/human nutrition; land use change and vector-borne disease; urbanisation and mental health; zoonotic disease emergence; freshwater scarcity and communicable diseases; natural disasters and human displacement; and air quality impacts of deforestation.

Global environmental change, driven in large part by human activities, profoundly impacts the structure and functioning of Earth’s ecosystems (Millennium Ecosystem Assessment 2005). We are beginning to push beyond planetary boundaries (Steffan et al. 2015), and the consequences for human health remain largely unknown (Myers et al. 2013). Growing evidence suggests that ecological transformations can dramatically affect human health in ways that are both obvious and obscure (Myers and Patz 2009; Myers et al. 2013). The framework of ecosystem services, designed to evaluate the benefits that people derive from ecosystem products and processes, provides a compelling framework for integrating the many factors that influence the human health response to global change, as well as for integrating health impacts into broader analyses of the impacts of this change