Panel Discussion – Public Health/Planetary Health/One Health

The current global pandemic has revealed stark structural injustices embedded deep in our society. Our approach to health has long neglected the relationship between socio-economic conditions, planetary health, and public health. As a virus that was transmitted from non-human animals to humans has placed the entire world on high-alert, it is time we reevaluate the relationship between planetary health and public health. The COVID-19 pandemic has laid bare the injustices that have forced communities of color to bear the brunt of the pandemic. This brings us to the central question: How do we rise to the challenge and radically restructure our entire approach to health? 

Moderated by J.P. Harpignies, this Bioneers 2020 conversation brings together two prominent leaders in the field of health. William B. Karesh, Ph.D., Executive Vice President for Health and Policy at EcoHealth Alliance, President of the World Animal Health Organization (OIE) Working Group on Wildlife Diseases and chair of the IUCN Wildlife Health Specialist Group. Howard Frumkin, Professor Emeritus, Environmental and Occupational Health Sciences, University of Washington School of Public Health, co-editor of the new groundbreaking collection Planetary Health: Protecting Nature to Protect Ourselves (Island Press).

This discussion took place at the 2020 Bioneers Conference. Watch more panels, keynote addresses, and performances from the conference.

J.P. HARPIGNIES: Let me begin with something painfully obvious: we’re all currently obsessed with COVID-19, as we have absolutely no choice but to be, given how dramatically that virus has impinged on all our lives. And one of the most painful aspects of this crisis, besides of course the immeasurable amount of death and suffering and economic hardship it is visiting on so many people, is that it’s also starkly revealing some of the most glaring injustices and deep structural flaws in our society.

We all know that we live in a system that’s a weird mix of plutocracy and democracy, and that the rich and the middle class have had better health outcomes and better healthcare as well as better educational opportunities and legal representation if they need it compared to people at the bottom of the social order. But even the most cynical among us have to be stunned by the extraordinarily disproportionate amount of suffering that’s been visited on the most disenfranchised communities, especially communities of color. 

One thing this crisis is clearly revealing is the extent to which human health is inextricably linked to social conditions, to the social order, to socio-economic factors. We have to hope that our society will take this as a wake-up call and that we will start addressing these gross injustices in the years ahead, not just in our public health system but in the broader society.

With that said, it is also important to understand that there are broader questions than just the socio-economic ones I just mentioned. This should be painfully obvious because COVID-19 is a zoonotic disease (and we have one of the world’s leading experts on zoonotic diseases here with us today) meaning it is a disease transmitted from animals to humans (as are so many of the epidemics and pandemics in human history, from the Black Plague through Ebola and SARS and MERS, and of course the common flu, etc.). COVID-19 being a zoonotic disease is an indicator that human health is inextricably linked to the health of the ecosystems in which human beings live, to the health of other species, to the health of the entire biosphere. That is part of what we’re going to be discussing today, this broadening of the concept of what human health is.

About 16, 17 years ago, we at Bioneers made an early effort to wrestle with this question. We published a book, a collection called Ecological Medicine in which we attempted to gather a number of voices from disparate fields who were all pointing arrows to this idea of a need to broaden the concept of public health. In that book we highlighted people from environmental justice movements, chemists working on toxicity in the environment, people working on eco-psychology, people working on urban design and architecture as they relate to health, leading advocates of the Precautionary Principle, activists with Healthcare Without Harm, etc. Since the publication of that text, other thought-leaders have come forward to refine and deepen that understanding and to come up with actual plans of action, and we have two of the most illustrious figures in those efforts with us today.

I’ll start with Professor Howard Frumkin, a physician, epidemiologist and Professor Emeritus of Environmental and Occupational Health Sciences at the University of Washington, who has held many major leadership positions: he led the Our Planet, Our Health initiative at the Wellcome Trust and served as Dean of the University of Washington School of Public Health, Director of the National Center for Environmental Health at the CDC, and Chair of Environmental and Occupational Health at Emory University. He’s served on countless boards and advisory committees for all sorts of governmental, scientific, professional, and academic institutions and is the author or co-author of some 250 papers and nine books, including Making Healthy Places: Designing and Building for Health, Well-Being and Sustainability. And one reason that we really wanted Howie on this session is that he co-edited a book, just put out by Island Press called Planetary Health, and in that text we recognized a much more refined and all-encompassing effort at doing what we had attempted in our book Ecological Medicine nearly 20 years before, so we felt we absolutely had to have him here, and I recommend that book highly to everyone.

I’ll now move on to our other interlocutor, William (“Billy”) Karesh, an absolutely legendary figure, one of the leading experts in the world on zoonotic diseases and on the relationship between human health and animal health. He is the one who is credited with coining the term “One Health,” which has become a very important concept, precisely pointing the way at this deeper understanding that human health is inextricably linked to ecosystem health. Billy is Executive Vice President for Health and Policy for EcoHealth Alliance, a leading organization working on zoonotic diseases. He’s also part of the USAID emerging pandemic threats PREDICT-2 program, an incredibly important initiative (which of course the Trump administration defunded as soon as it came to power, simply because it was the most important and most significant group of people working on zoonotic diseases on the planet…)

Billy is also a member of the World Health Organization’s IHR Roster of Experts. He’s the President of the World Organization for Animal Health Working Group on Wildlife, and is involved in more projects than I have time to list. I really want to drive home that Billy is not an armchair theoretician: he is the one who traced the origins of bird flu and collected a sample of a virus from a wild swan that was then later used for the human vaccine worldwide. He has led projects in over 45 countries from Argentina to Zambia. His team proved the connections between Ebola outbreaks and the use of bush-meat in Africa; found the MERS Corona virus in camels in the Middle East; and the closest relative of the COVID-19 virus in bats in Asia. His is truly an extraordinary record.

So I can’t think of two people better suited to helping us expand our understanding of public health. We’ll start with Howie.

HOWIE FRUMKIN: It’s really an honor to be here, and to be here with Billy. I think we’ll do a nice one-two punch. I’ll focus on some broader themes in planetary health, including climate change, and Billy will talk about zoonotic diseases and spillover, and I think this will be a nice comprehensive overview of links between our planet and our health.

I’m going to speak from the perspective of the emerging field of Planetary Health, and I’ll start with some history. I’m going to take you back to the year 1860. England is exploiting coal on a very large scale, and around the same time, the Drake Well, the first oil well in the U.S., was drilled in Pennsylvania, all that helping initiate the Industrial Revolution. Those two places in the mid-19th century mark the beginning of the modern planetary health story. A massive upscaling of the use of energy worldwide began then. Within 50 years, fossil fuel was exploding, and our species was using far vaster amounts of energy than had ever been the case in human history.

That enabled us to do a lot of things. One of them was to reproduce. An extraordinary post-Industrial Revolution population explosion began. We’ve also seen a huge increase in economic activity. GDP, not the best measure of human success and prosperity, but a good measure of throughput of energy and materials, skyrocketed too. In fact, almost any indicator of the human enterprise—water use, transportation, the damming of rivers, travel, the number of McDonald restaurants, you name it—almost any indicator has been skyrocketing in a phenomenon since the second World War called “The Great Acceleration.”

That led to extraordinary improvements in the human condition. On average, this is the best time ever in human history to be alive. During this great acceleration, illiteracy, infant mortality and poverty have gone way down, and life expectancy has gone up, and that is all good, but those gains have come at a high cost. The use of energy and the technologies enabled by that energy have led to major alterations in the Earth. The chemistry of our atmosphere now has far higher levels of carbon dioxide, nitrogen oxide and methane; the pH of the ocean is different; the use of land around the planet is different; the availability of water and soil is different. All in all, the planet we inhabit is not our grandmother’s planet.

40% of the Earth’s ice-free, non-desert surface has been appropriated for agriculture; 46% percent of the world’s original forests have been cut down (and that deforestation is continuing to rise in many parts of the world); about half the world’s freshwater is being appropriated, mostly for agriculture; 60% of the world’s rivers are now dammed; more than 90% of fisheries are exploited beyond sustainable limits; and we are losing species at about a thousand times the baseline rate of species loss. All of that has led to what’s now being called the Anthropocene, a geological epic characterized by human control and influence on the entire planet’s patterns. That has also given rise to the notion of planetary limits, the idea that if we push these limits, if we push climate change beyond a certain point, if we keep pushing ocean acidification and species loss, that will induce irreversible and disruptive changes in Earth systems that will in turn induce immense human suffering.

How do all these planetary changes relate to human health? There are two main frameworks that can help us understand those links. One is the notion of ecosystem services. Natural functions support human well-being in countless ways. To mention only a few, through nutrient cycling and soil formation, they provision us with food and fresh water. They regulate phenomena, such as climate and flooding, that would otherwise threaten us, and they offer us cultural services such as aesthetic and recreation services. So intact planetary systems deliver ecosystem services that protect and advance our health, and disrupted planetary systems threaten us, and as disruptions to planetary systems increase, impacts on human health increase.

This is a reframing of insights that we’ve had for decades and really for centuries if we look back to Indigenous knowledge, but the modern notion of Planetary Health as a field arose in 2014 with a declaration in The Lancet, the prestigious medical journal. The essence of it is that we have to understand the total interdependence of human systems, including health, with natural systems. One example of how this plays out is climate change. Increasing emissions of carbon dioxide from burning fossil fuels have led to planetary disruptions including rising temperatures, sea level rise, weather extremes, and all the other physical features of climate change. And Increasing summer temperatures cause heat stress, cardiovascular problems, diminished work capacity and so on. Sea level rise and severe weather cause a rise in both short-term acute fatalities and injuries and long-term consequences, including on mental health. Warmer weather leads to higher levels of ozone in the air causing respiratory and cardiovascular problems. Allergenic plants such as poison ivy thrive under conditions of high CO2 and warmer weather, so allergy attacks shoot up. Infectious diseases, both vector and water-born, become more prevalent. Disruptions to the water and food supply threaten nutritional status in many parts of the world; etc., etc.

And actually this is an oversimplification of the problem because many of the impacts of climate change occur indirectly through complicated pathways mediated by environmental and social factors, leading to a wide range of disparate challenges, such as, say, increasing food prices and changes in microbial ecology, and all of them generate large-scale health impacts. Seemingly separate things can be completely interrelated and in complex relationships. Take heat: in many parts of the world people are being exposed to levels of heat both acutely through heat waves and long-term through a new, much higher average temperature than that to which they had been accustomed. Heat waves are catastrophically bad: people die, especially the very young, the very old, the poor and socially marginalized, and people with certain medical conditions. The numbers can be frightful—70,000 deaths during the 2003 European heat wave; 54,000 during Russia’s 2010 heat wave; uncounted thousands in India during each of several recent summers. People can adapt to heat, but only to a point, and in many points of the world, the Arabian Gulf as a prime example, levels of heat are reaching the point that exceed human adaptive capacity.

But it’s not just that people die during heat waves. Heat threatens health in numerous, far less obvious ways. During periods of hot weather, episodes of violence increase. Suicide rates increase during hot weather. Kidney disease increases during hot weather, especially among outdoor workers who don’t have access to plenty of fresh water. Food borne and water borne infections increase because it’s very hard to keep food and water sanitary and disinfected when the weather is very hot. Sleep disturbances are more common in hot weather, and sleep disturbances in turn increase the risk of cardiovascular disease, mental health problems, and other health outcomes. Abnormal birth outcomes increase during hot weather. Academic performance among children in schools decreases during hot weather, as does work performance. People exercise less during hot weather, and sedentary lifestyles, as we all know, are a risk factor for cardiovascular disease, cancer, depression, and other conditions. Workers are affected in several ways. One is that the risk of injuries increases during hot weather; workplace injuries rise dramatically. And perhaps more importantly, work capacity decreases, aggravating poverty and all of the health consequences that flow from poverty.

So heat, as you can see, takes very complex multifaceted pathways in its health impacts, but heat is just one of the many ways climate change and environmental degradation affect human health, and very, very deeply embedded in all of this an equity concern. The wealthiest among us globally have much larger carbon footprints than the poorest across the board: the food we eat, the housing we inhabit, the goods we buy, the way we travel. So the responsibility for climate change should rest with those who are well-off and intense consumers of goods and energy, but in fact the consequences of climate change fall disproportionately on those who are poorest. This is a justice issue that exists both within countries and between countries.

This is all grim news to hear, and there is no doubt these are major challenges, but there is also some good news. To preserve planetary systems, combat climate change, stop biodiversity loss and so on, we need a green economy based on clean energy, well-designed cities, healthier diets and green chemistry. If we take steps toward each of these improvements, we will radically improve health as well.

Clean energy reduces air pollution and delivers less heart and lung disease. Well-designed cities with ample green spaces, good public transit including pedestrian and bicycle infrastructure, deliver substantial health improvements. Healthy diets with less meat and more organic food help the planet while resulting in less heart disease and cancer. Green chemistry, i.e. designing chemicals that are not bio-accumulative, not persistent in the environment and not toxic also reduces the incidence of many illnesses, so there is no question that tackling the planetary crisis will also deliver far-reaching, widespread health benefits,

Despair is an occupational hazard for anybody who thinks seriously about planetary changes, but we need to fight despair because it’s immobilizing and doesn’t accomplish anything at a moment when we have to be about accomplishing a lot. We have to embrace hope ourselves and we need to inspire hope in others. Fortunately, there is a lot of basis for hope. Green technologies are advancing. We’re developing better battery storage and ever more efficient and cost-competitive renewable energy sources. Policy is maturing too: we’re seeing carbon pricing and other very far-reaching policies around the world. Activism is blossoming. Public opinion is shifting. Change is happening around the world, and Planetary Health offers us a new, solutions-driven, people and equity-centered, systems-based framework to achieving far better human health and well-being. We are looking to the future to try to design enduring and sustainable solutions. For those who would like to learn more, here are links to the first textbook in this new field we just published (, and to the Planetary Health Alliance (

BILLY KARESH: Some of our work over the years has been looking back at what causes and what drives emerging infectious diseases. A large proportion of these emerging infectious disease are zoonotic (i.e. linked to animals), but not all of them are. We try to do thorough analyses and get an objective look at the distribution of where emerging infectious diseases have happened over the decades, but it’s hard to get really objective data, because a lot of the information is biased: it depends on where research is done, where there are academic institutions and good hospitals that can perform good diagnoses and do solid reporting.

But as we look at the underlying risk factors and at what the correlations with specific diseases are, we are still able to start to tease out what’s behind these emerging infectious disease events. We study non-infectious diseases and antimicrobial resistance patterns globally as well, but right now I’m just going to talk about emerging infectious diseases. One thing we’ve seen is that in the last 50 or 60 years or so land use in many places has changed a lot, mostly due to the expansion of agriculture and the food industry. International travel and commerce have also grown immensely, and that combination facilitates the introduction of new diseases or of old diseases into new places. It’s not our grand and great-grandparents’ planet anymore. What we’re doing now is dramatically different, and the places where there’s been the most disruption and change are the ones at greatest risk for disease emergence and where we need to focus our energy.

Where the greatest risks are is where we need to focus our surveillance activities, so a lot of our efforts have been in hot spots of emerging diseases. I’ll use the current COVID-19 pandemic as an example. In looking at Corona viruses we’ve found that they are related to the first SARS virus. COVID-19 is actually technically SARS COVID-2. These types of viruses are found in bats throughout Asia, so a lot of our work in the last several years has been in China with Chinese colleagues. We’ve so far identified about 500 different Corona viruses in bats in Asia, over 100 of which are closely related to SARS. And these viruses have been circulating in bats for millennia. They’re completely natural.

Our approach is to systematically first look at animals and, in this case, identify the viruses in bats, and then go out and work with local communities to sample people to see if they have been exposed. What we have found is that a significant percentage of people already have been exposed to this group of Corona viruses, and this has been going on for years. Somewhere between a half of a percent to three percent of people in Southern China alone where we were working had antibodies to these viruses—that’s somewhere between 3 and 20 million people we estimate already had antibodies to these groups of viruses before the pandemic began. This exposure had been a long-term, very natural process, but there were more and more people in these regions, and these humans are disrupting habitats and coming into contact with wild animals more and more, and all it took was that in one of those infected people that virus mutated and became transmissible from human to human, just like HIV/AIDS virus, which we knew originated in animals and got into people and at some point became transmissible from human-to-human.

At this point I’d say that COVID-19 is no longer a zoonotic disease. It has zoonotic origins, but it’s now a human disease, and we’re not sure when that happened. It could have been recently or it could have been decades ago. We know that bats have these viruses and where those bats live, and where the most human beings are likely to come into contact with bats, so we map the “hotspots” of the places where the risks are highest of those viruses getting into people. That’s where we focus our efforts to get out there and reduce the risk, reduce the burden of disease and reduce the risk of new pandemics.

One of the things we’ve been doing is getting out into hotspot communities and doing direct education, informing people how to live safely with bats. We can’t just sit here at home and wait for the next pandemic and then wait for somebody to come up with a vaccine, and then wait for somebody to pay for that, and wait for it to be distributed, and then hope people actually will take the vaccine. If we can make more of an investment upstream, in prevention, in community engagement, in teaching people how to reduce their risk, we could save many lives and a lot of money. For example, a lot of people farm bat guano, bat feces, as fertilizer. If people are going to do that, they need to be educated to be able to do it safely to reduce their risk of infection. Some people eat bats. Some people go in caves where bats live for tourism. There are things we can do to reduce exposure through education. We can’t prevent every infection, but we can reduce risk.

We did some work last year about global health security and where the investments go. We looked across a stream of activities at a global scale and broke down health security into prevention, detection, response, and recovery. Nealy all the money goes to response. If you look at all the big organizations in this domain around the world, you see that everybody loves to do response to emerging disease outbreaks. Everybody shows up. Everybody watches the fire. Everybody comes to watch the building burn down. All the firemen are there. Everybody’s there, but there’s very little investment in prevention. There’s a little bit spent in early detection but very little for prevention or for recovery, which is typically ignored too. After the outbreak, after the disease, everybody goes home. The local people are left poorer than they were before, with fewer resources than they had before, and they’re left on their own for recovery. In fact, though, recovery is really the first step for prevention for the next one, the future outbreak, so we’re trapped in a circular pattern.

As Howie mentioned, changes in land use, in the way we’re doing agriculture, ecosystem deterioration and climate change are all linked to negative health outcomes. In the healthcare/medical community we’re kind of at the end of the garbage dump. We’re dealing with the sick people at the end of a process, but it’s always a better idea to try to stop problems at their source instead of always responding when the damage has been done. A solution for traffic fatalities is not necessarily more emergency rooms, it’s better engineering for traffic flows and car safety, better laws and regulations. The way a road is designed can save lives. We need to think that way about planetary health.

There’s been a lot of talk about wet markets and the wildlife trade, which we know are sources of infectious zoonotic diseases, but hundreds of millions to probably billions of people on a weekly basis are getting their food from this type of system, which are without doubt breeding grounds for infectious diseases and can lead to pandemics. We know poultry markets are linked to pandemic influenzas. People buy bats to eat at markets, and we know they’ve been linked to Ebola, henipaviruses and the corona viruses we’ve been talking about. Given how many people depend on these markets globally, closing them is not feasible, so we’ve been seeing what we can do to reduce their likelihood of being sites that spread novel infections. We’ve been working on how to bring refrigeration to these markets in super energy-efficient ways, including with new technologies such as cold storage that uses frozen liquid natural gas that uses zero electricity; and, relatedly, working on radically reducing food waste (which can reach 30 to 40 percent) in this system. These measures are win-wins that combat climate change, boost livelihoods, improve health overall, and reduce the spread of novel zoonotic viruses.

We need more of these sorts of solutions, and now in the 21st Century, we’ve got a new generation of people who are really thinking big about how to solve some of these problems, but we have to understand that these diseases don’t just emerge mysteriously. Their emergence and spread are the result of what we are doing on this planet. We broadly know what their sources are, and we know which industries and economic sectors we need to engage with do something about it.

The world is really different than it was for our great-great-great grandparents. The world used to be a mostly a place covered by vibrant ecosystems filled with wild animals. The planet was mostly covered with forests and grasslands and deserts, while today the planet is mostly covered with humans and livestock, so we should not be surprised that we are seeing changes in disease patterns when our planet is so different than when we humans evolved to live on it.

It doesn’t matter to me whether we frame these efforts as “One Health” or “Planetary Health.” As long as people are trying to do something positive that will have a real impact, I’m happy. On our end, we’ve been doing a lot of work with the World Bank to help people think through how to get different sectors and all the confusing world of intergovernmental organizations and national governments’ various branches and all the planning tools and funding sources and regulatory environments coordinated and aligned enough to get the right projects and initiatives up and running without interfering with each other or duplicating efforts. It’s definitely confusing, but I’ve been really working with the Bank to provide clear roadmaps and a new series of assessment tools that countries and organizations can use to find the right entry points to get engaged in the most productive ways depending on their capacities and domains of expertise.

And countries are doing this. We’ve worked with Zambia and Zimbabwe, for example, to name just a couple, on biodiversity strategies, antimicrobial resistance plans and their national disaster risk assessments, so they can link these strategies and get all the parts of their governments and civil societies and international organizations all working together in a coordinated fashion to achieve their goals.

JP: Thank you Howie and Billy for those thought-provoking presentations. Now we’re going to tackle a few questions from the audience. The first is about the problem of trying to choreograph the type of holistic coordination of many varied fields you both described as being essential to solve our problems in the context of the intense specialization into highly siloed fields that characterizes modern society.

BILLY: Specialization is of course necessary in an advanced society. If I ever needed brain surgery, I would like a really good brain surgeon, not a podiatrist, performing the operation. But to solve bigger, large-scale problems, we need somebody or something to force us to work together. I’m not big on building bigger bureaucracies, so maybe it’s just a heightened awareness and openness about building partnerships, and I do see that happening. When we started with One Health and Planetary Health, we were successful at getting physicians and medical professionals more engaged in these efforts, but we’re still missing the engineering side. I think we need more engineers and designers involved as well as more risk-reduction experts from the insurance industry. Buildings don’t burn down as quickly anymore in developed countries because we designed better materials and smoke detectors and building and fire codes and insurers won’t cover you if you don’t build that way. We need to apply some of that sort of thinking to the problems we’ve been discussing, and I do see it happening. I see this next generation just bubbling up here in the 21st Century that I think is really ready to take on these issues and to work together. They are reaching out to each other and developing new types of networks and partnerships, so I have a lot of hope.

HOWIE: I completely agree. Education matters a lot. I think we ought to be developing educational strategies that help people think upstream, think like systems thinkers and go into whatever specialty they choose, but with a broad appreciation of how what they do can connect with other goals. We need to think about new measurement tools as well. GDP, for example, as a standard measure of prosperity, measures all the wrong things. If we can go toward composite indices that measure things like biodiversity, the quality of air and water, reported levels of happiness among people, life expectancy, etc., those are better measures of societal success, and if you go that way in your measurement, you have no choice but to think like a systems thinker and aim for composite multi-sectoral solutions.

JP: Some audience members are asking what they can do in their own lives, such as avoiding consuming palm oil or hardwoods from tropical forests, or how to go about mobilizing others in their professions or communities, and so on. Can either one of you offer what you think are some of the most tangible things that people at large can do to help contribute to these initiatives?

HOWIE: There’s a very interesting debate going on now in the environmental world, and to some extent in the health world, about whether individual behavioral changes are the right way to go or if they don’t matter because only complete system change can save us. Those who believe we need radical system change sometimes argue that it’s pointless to focus on choosing what you eat and consume or how you travel, because those individual choices at the end of the day won’t be enough to bring about the system change that we need. My own view is it’s both/and not either/or.

People in their personal lives can make a lot of choices: eating less meat; buying renewable and sustainable products and materials; traveling by bicycle or foot instead of by internal combustion vehicle; and so on. Those are choices that if aggregated over entire populations, especially high-consuming populations such as here in the U.S., will make a difference. They’ll drive demand for more virtuous options; they’ll drive innovation; they’ll reduce consumption. But at the same time one of the most important things you can do is to vote (and agitate and advocate) for political and corporate leaders who are more likely to make systems change.’s campaign to get the banks to divest from fossil fuels and all the campaigns to elect leaders committed to actually addressing climate change, these are extremely important. Each of us exists as an individual making personal choices, but each of us also exists as a citizen obligated to push for system change as well.

JP: Do either one of you have any thoughts about the new administration? Are you hopeful?

BILLY: Yes, many of the people in the new administration were working very seriously on pandemics and the Ebola outbreak in West Africa and on climate issues in the Obama administration. It’s certainly no time to be complacent, but these folks are on it.

HOWIE: There are indeed very good people coming into position in the new administration. I think we can be really confident. That said, you know, government is big and government is siloed, and so it’s difficult to implement cross-cutting solutions. I think one of their biggest challenges will be to bring about action not only in the misnamed Department of Energy (it’s more about nuclear weapons than energy; we could use a real energy department), but we will also need climate action in the departments of Transportation, Agriculture, Health, Housing and Urban Development, etc. One of the big challenges will be getting the whole of government working on coordinated, integrated systems-based solutions to the climate and environmental and health crises.

BILLY: I agree completely. Government has traditionally been very siloed. I’m hoping maybe we get some new thinking this time. Agriculture is a great example of that: agriculture is major generator of carbon emissions and one of the main drivers of both climate change and the spreading of emerging diseases. Traditionally our USDA has been there to support large U.S. agricultural industries and export crops. When our country deals with the UN on agricultural issues, it’s almost completely focused around bolstering domestic farm profits by selling more of our crops abroad, not on climate and food security, let alone emerging diseases or deforestation or overfishing. All that is agriculture and the food system. We are the largest donors to the international agricultural and food agencies, so there’s no reason why we couldn’t ask for better systemic thinking on how funds are used, and to offer some leadership on climate there, instead of just pushing our corn and cows on the global market, but it would require a major change of direction for the USDA.

HOWIE: A related issue is equity, global equity, not dictating what other countries do but sensitively and collaboratively moving towards solutions, and we have to do the same thing domestically. We have to be very aware of the disparities in our society, of racism, of inequities, and of how all of the health impacts we’ve talked about fall disproportionately on those who are least fortunate and suffer discrimination. So solutions must include the engineering solutions Billy mentioned but also social solutions and changes in the way we think, so that we can move toward a society that is lower consuming, more equitable, more future-oriented, and more about stewardship and solidarity than about conquests and profit.

JP: Do you have any thoughts on how to contend with the intense resistance of entrenched interests, be it the fossil fuel industry or agribusiness or big pharma, that have been really Machiavellian in their relentless stymying of progress on so many fronts and have waged enormous disinformation campaigns?

BILLY: I think consumer choices can make a big difference because businesses are in business to make money, and so as consumers start want different products, businesses will have to come around. We’ve seen that with the enormous growth of the organic food in the past 20 years ago. The same will happen with electric cars. I have faith in the new generation, and they are entering the energy field, so I think there’s a lot of hope.

HOWIE: I’m a little less sanguine. I think that the persistent disinformation as we saw in the tobacco industry and then in the fossil fuel industry needs to be countered, not just by increasing consumer demand for better products, but also by direct confrontation. The campaigns to disinvest from fossil fuels, to force investors to reckon with climate risks as they make investments, to stop the construction of fossil fuel infrastructure—those are all in my opinion as important as changing consumer demand for products. We’ve now also seen a lot of disinformation with COVID. The entirely unregulated and remarkably large-scale and rapid distribution of disinformation on such platforms as Facebook and Twitter really is a problem. I don’t know the answer, but I think we will probably need some regulation of social media, maybe even the re-operationalizing of how we protect and defend freedom of speech in a world where speech is a very different process than it was at the time the Constitution was being written. Disinformation will somehow need to be addressed.

JP: Do you have any closing thoughts, any closing words of wisdom to offer?

BILLY: Try to get engaged. Try and contribute a little something, even if it’s not your full-time job. Align your individual behavior and attitudes with your highest ideals and talk with your friends and family, and spread the word about the solutions we all need to work on together to get to. Health, for example, doesn’t belong to the medical community. It belongs to all of us, to society, and we have to start thinking about it with an all-of-society approach, in which everybody gets to participate.

HOWIE: I’d say be hopeful, don’t despair. We need all of our hope. We need to roll up our sleeves and move toward a better future. And there’s reason for hope, so this is not just a fatuous piece of advice, Evidence-based hope is a powerful thing. And think as broadly as you can. If you’re a health professional think about other things than health. If you’re an engineer, think about other things than engineering. All of us ought to be looking for the broadest solutions that we can. Think upstream. Look for cross-cutting co-benefits. Think about the future. Be a good grandparent. Above all, have hope.


Howard Frumkin, MD, MPH, Dr.Ph, a physician and epidemiologist, Professor Emeritus of Environmental and Occupational Health Sciences at the University of Washington, previously led the Our Planet, Our Health initiative at the Wellcome Trust. His many other positions have included: Dean of the University of Washington School of Public Health, Director of the National Center for Environmental Health at the CDC, and Chair of Environmental and Occupational Health at Emory University. He has served on the boards or advisory committees of a wide range of leading scientific, professional, academic and governmental institutions and is the author or co-author of over 250 scientific journal articles and nine books, including Making Healthy Places: Designing and Building for Health, Well-Being, and Sustainability; Environmental Health: From Global to Local; and most recently: Planetary Health: Protecting Nature to Protect Ourselves (Island Press, 2020).

William B. Karesh, Ph.D., a leading global expert on infectious diseases, wildlife and the environment, is Executive Vice President for Health and Policy at EcoHealth Alliance, President of the World Animal Health Organization Working Group on Wildlife Diseases, chair of the IUCN Wildlife Health Specialist Group; and serves on the WHO’s International Health Regulations Roster of Experts focused on the human-animal interface and wildlife health. Currently EPT Partner Liaison for the USAID Emerging Pandemic Threats PREDICT-2 program, Dr. Karesh coined the term “One Health” in 2003 to describe the interdependence of healthy ecosystems, animals and people and has pioneered solutions-oriented initiatives with this concept as the guiding principle in programs under his direction in over 45 countries from Argentina to Zambia. He has published 180+ scientific papers and written for broader audience publications, including his highly acclaimed first book for a general audience, Appointment at the Ends of the World.

J.P. Harpignies, Bioneers Senior Producer, affiliated with Bioneers since 1990, is a Brooklyn, NYC-based consultant, conference producer, copy-editor and writer. A former Program Director at the New York Open Center and a senior review team member for the Buckminster Fuller Challenge from 2010 to 2017, he has authored or edited several books, including Political Ecosystems, Delusions of Normality, Visionary Plant Consciousness, and, most recently, Animal Encounters.

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