Planetary Health is the Solution: Interview with Carlos Faerron Guzmán, Associate Director of the Planetary Health Alliance

On the occasion of World Environment Day this year, we revisit the relationship between environment and health through the concept of planetary health. In this interview, we talk to ISGlobal Visiting Scholar and Associate Director of the Planetary Health Alliance, Dr Carlos Faerron Guzmán, about the growing ecological crisis, its impact on health, and how we can contribute to the planetary health movement.

You began your career as a primary care doctor in Costa Rica. How has living and working in Costa Rica inspired you to work in Planetary Health?

I was a very typical student in my university years. I graduated in 2010 from medical school at the Universidad de Costa Rica. I was initially very clinically-oriented, and wanted to be a pediatrician. In my last three months of medical school, I wanted to get out of the city for an internship, so I chose a community and family medicine rotation that was in the “deep south” of Costa Rica, in a little town bordering Panama, called San Vito de Coto Brus. This town is extremely exuberant in nature and is also quite well-known as a place where a lot of health system innovation happens. So my segway into public health was through the health system in Costa Rica, especially through my experiences of working on increasing access to healthcare for Indigenous Peoples in the south of the country, and also working with migrating populations coming from different parts of the world and funneling through the border between Costa Rica and Panama. 

Being from Costa Rica, I witnessed an intrinsic intersection in how nature influences the well-being of societies. Costa Rica is a leader in developing and implementing environment-centered policies. While there are challenges that remain to be solved such the use of pesticides and protecting our rivers Costa Rica has made early progress to be forward thinking in environmental policy. I think this inspired my professional path and I started working in that intersection between human health and the natural environment, and that’s how I got involved in planetary health. The natural environment really influences how I understand what makes people healthy.

The natural environment really influences how I understand what makes people healthy

Since the discipline of “Planetary Health” has been introduced by the Rockefeller-Lancet Commission in 2015, several definitions have been proposed. What is your own personal definition of “Planetary Health”?

I like to think of planetary health not just as a scientific discipline, but also as a “solutions seeking” movement. Planetary health is not just about trying to understand how natural systems are changing due to human activities and how this impacts our health and that of the environment. Planetary health also aims to understand how we generate innovative and comprehensive solutions. I always say that planetary health is very much an “AND” field, not an “EITHER OR” field. It’s not one discipline, it combines several disciplines. It’s not one sector of civil society, it’s several sectors of civil society. I really push people to see planetary health as an umbrella in which we can all take action and converge towards solutions to confront common challenges not just as a species, but as a planet. So, to summarize: planetary health is a field of study and a movement that tries to shed light on how anthropogenic changes to the natural systems are causing changes in the burden of diseases, and it uses current and emerging approaches to create innovative and converging solutions.

You are the Associate Director of the Planetary Health Alliance (PHA). What does the PHA do? 

I like to explain what we do at the Planetary Health Alliance in three large buckets of work.

First, we try to facilitate the understanding of the complex and daunting challenges that we have ahead of us. We try to communicate the complexity in an understandable form for everyone: scientists, communicators, civil society, and the population in general.

Second, we try to provide hope and motivation to different actors across the world. We strive to enable and empower them to act and to contextualize what planetary health means in their context, their lives and in their futures.

Third, we try to provide different tools and frameworks for people to take action that is convergent, aligned and can be more impactful and innovative in facing these challenges.

The Alliance’s focus is in the network-building aspect of planetary health. We see ourselves as a “backbone” organization; a nerve center of the activities related to planetary health, especially in the education and research realms. We try to connect actors across the board and provide resources to diverse stakeholders. 

Planetary health is a field of study and a movement that tries to shed light on how anthropogenic changes to the natural systems are causing changes in the burden of diseases, and it uses current and emerging approaches to create innovative and converging solutions

So, what is your ambition for the Alliance?

The Alliance has strong core tenets of what its mandate is and what we should be working towards. The ambition is growth: strengthening the network and enabling the participation of increasingly diverse actors. We believe that a strong community of actors is essential to “move the needle”— to create new structures, policies, ways of understanding our relationship with nature, and to offer new solutions. The Alliance aims to facilitate the platform for these collaborations to emerge. That is our vision for the PHA.

We are in a growing ecological crisis, and time is short. What should we focus on?

The key to moving the needle is being explicit about the fact that there is no one thing that we should be focusing on. We should stop being so deterministic, simplistic and reductionist, and stop trying to find a silver bullet that will magically change the situation. There is space for everyone in planetary health and convergence of a diversity of disciplines and voices is particularly important. To address your question succinctly, I don’t want to fall into the trap of narrowing it to “the most important” area to focus on, however if we do a root-cause analysis I can say that one of the conversations that we really need to be having is about ‘values’. We need to ask ourselves: What values do we want? What values are shaping our actions, our policies, our projects, our research? Rethinking these values and our economic system explicitly becomes the main driver for change. Designing a system for the sake of growth is different from designing a system for the sake of equity. That’s an example of how values can drive systems change. 

Rethinking our values and our economic system explicitly becomes the main driver for change

We live in the Anthropocene, an era defined by human-modifications of natural environments, and by our disconnect from nature. Why is it important to reconnect with nature? 

When you look at some reasons why nature is changing, focusing on what is most upstream, there is a sense of disrespect and disconnection from our natural environment. We have forgotten to ask where our food and energy resources come from. By really being far from nature, we are not able to understand how our well-being is connected to natural systems, and thus, we justify the destruction of nature and the excessive extraction of natural resources. Everything from the use of digital technology and how this separates us from our natural environment, to the mental simplification of complex processes are disabling people from seeing the wider context. Among many other things, we have seen nature as where humans can gain, instead of seeing an interdependent relationship. We have come to believe that nature is there for the benefit of humans. We don’t see coexistence, instead, we see a power relationship between humans and nature. It is time to retrace our steps to the ways humans related to nature many years ago. Many indigenous cosmovisions are emphasizing that we must return to the idea of respect and interdependence with nature. If we manage to reframe our relationship with nature, our economic, food and energy systems will change drastically. 

If we manage to reframe our relationship with nature, our economic, food and energy systems will change drastically

How can education help us reconnect to nature? 

There are ongoing efforts to understand this and a lot of answers remain to be found. Part of the process includes understanding the starting point: how did we start disconnecting from nature. Disconnection starts with the distancing from our most proximal context: our city, our house, the people around us, the air we breathe. When we push everything into the digital form, or what is now called the “metaverse” in which we coexist, we are pushing people into the digital world, away from their surroundings. So, education in its’ format can’t be all digital: there needs to be an experiential component embedded in nature that allows students to explore their relationship with nature. Even on digital platforms, students must be encouraged to interact with their context and environment. Education is something that most of humanity is exposed to at some point in life: primary, secondary and/or tertiary education. If we can teach kids and adults in classrooms about the importance of nature, our relationship with nature and how it determines our well-being, there will be a shift in our attitude towards this relationship, which we are already seeing in some communities. 

What are the challenges you face with Planetary Health education? 

I will speak of challenges around higher education, but there are also other challenges around other types of education. First, there is the idea of the cycle of competencies—how they are created and designed— which creates a rigid structure that doesn’t allow for flexibility when we want to incorporate new education elements. For instance, certifications in public health programs demand that certain topics in the curriculum are covered to complete certain competencies. But when you try to incorporate themes like planetary health, there is very little space to do that. It happens as well in medical education among other health professions, where competencies are classically used to design education programs. The cycle of how these are renovated becomes the problem, because these are very slow cycles that require a lot of time to change. This is one of the guiding structures in education, therefore it becomes one of the barriers to incorporate planetary health education at this moment.  

The other challenge is the fact that planetary health by its core DNA is inter and even trans-disciplinary. When you have university structures that are siloed and hierarchical, and there aren't a lot of cross-disciplinary interactions, it becomes difficult to teach and structure planetary health programs within universities in their most conventional structures. Often, the universities don’t know where to put planetary health, they have to start thinking about different placements for faculty and it gets messy.  

I don’t think there are challenges around motivation, since most people are very much aware about how these threats to the environment are affecting our health. However, some barriers that I was mentioning might diminish the motivation to keep incorporating planetary health education. 

If we can teach kids and adults in classrooms about the importance of nature, our relationship with nature and how it determines our well-being, there will be a shift in our attitude towards this relationship

What is your message to the European academic community? What can researchers, educators and students do to tackle these challenges?

One of the most important things is to not stay in your own bubble. To use a nature analogy: be like a pollinator; traveling from flower to flower is good. Having conversations with people from different disciplines, reading other journals from different disciplines, applying different methods: there is a flurry of things that researchers can do to step out of their comfort zone and start learning about more interdisciplinary approaches, methods and theories. Even trying to publish in different journals is a challenge that most disciplines should be undertaking. I encourage interdisciplinary teams among students. In the classroom, trying to have representation of not just health students, but also engineering students, data scientists, social scientists, humanities students, among others. Having them talk to each other and understand the lenses that they are using can be really enriching. So, my advice to people: step out of your bubble, step out of your comfort zone. The other thing would be to look at your research, take a few steps back and look at it from a high vantage point. Try to map the theory of change that you want to see in society, where does your research fall, try to connect with other research efforts that are taking place around you, and try to converge towards common solutions within that theory of change that you have charted.  

What is your message to healthcare professionals?

Health professionals are one of the key professionals who are trusted messengers all over the world. As such, people look up to you for opinions and advice. That is a vantage point that few professions around the world have. With that vantage point in mind, become advocates for the change you want to see. Learn about advocacy and communication, step outside of your clinical environment in order to understand that the impact that you can have as trusted messengers can be many fold. So, I encourage all of you to become advocates for change, not just clinicians. If we can create a critical mass of healthcare professionals that are advocating for the changes that we want to see, that would definitely be part of how we accelerate the change and move the needle faster.  

If we can create a critical mass of healthcare professionals that are advocating for the changes that we want to see, that would definitely be part of how we accelerate the change and move the needle faster

What do you take away from your visit at ISGlobal?

First, the energy of the organization; it’s very vibrant. The representation of different geographies really makes it a vibrant place. There seems to be a lot of good leadership that is helping the institution take not just baby steps, but big strides to innovate.The other thing I take away is the innovative governance structure. Since ISGlobal was formed by the merging of two institutions, it now has a representation and partnership from different universities, government institutions, and even philanthropy and civil society. These diverse stakeholders are coming together to set the agenda for the institution. I am very excited to be part of the ISGlobal family, I look forward to coming back. I look forward to seeing how ISGlobal can be a trailblazer in creating institutional structures for interdisciplinary work that has an impact in the real world.