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The Lancet–Chatham House Commission on improving population health post COVID-19

2020; Elsevier BV; Volume: 396; Issue: 10245 Linguagem: Inglês

10.1016/s0140-6736(20)31184-3

1474-547X

Harry Rutter, Richard Horton, Theresa M. Marteau,

Global Health Care Issues

The health of populations across the planet is in a perilous state during the COVID-19 pandemic, with more than 550 000 deaths worldwide as of July 10, 2020.1WHOWHO coronavirus disease (COVID-19) dashboard.https://covid19.who.int/Date: July 10, 2020Date accessed: July 10, 2020Google Scholar The disease burden is falling mainly on the most disadvantaged groups worldwide and there are major impacts on health systems across high, middle, and low-income countries. In parallel with these direct health impacts, the economic effects of lockdowns are leading to an unprecedented global recession which will have ramifications well into the future. But while the focus is, rightly, on responding to the immediate threat of the pandemic, it is important to remember that over 40 million people die each year from non-communicable diseases (NCDs), more than 70% of all global deaths.2WHONoncommunicable diseases.https://www.who.int/news-room/fact-sheets/detail/noncommunicable-diseasesDate: 2020Date accessed: June 30, 2020Google Scholar Meanwhile, the climate and extinction crises pose unprecedented challenges to our planet, with government responses—as yet—inadequate.3Balmford A Fisher B Mace GM Wilcove DS Balmford B COVID-19: analogues and lessons for tackling the extinction and climate crises.Curr Biol. 2020; (published June 28.) (preprint)https://doi.org/10.1016/j.cub.2020.06.084Summary Full Text Full Text PDF Scopus (10) Google Scholar Global temperatures are set to increase substantially over the coming decades, leading to untold health, environmental, and economic consequences,4Watts N Amann M Arnell N et al.The 2019 report of the Lancet Countdown on health and climate change: ensuring that the health of a child born today is not defined by a changing climate.Lancet. 2019; 394: 1836-1878Summary Full Text Full Text PDF PubMed Scopus (887) Google Scholar, 5Bauwens M Compernolle S Stavrakou T et al.Impact of coronavirus outbreak on NO2 pollution assessed using TROPOMI and OMI observations.Geophys Res Lett. 2020; (published online May 8.)DOI:10.1029/2020GL087978Crossref Scopus (462) Google Scholar while the unfolding sixth mass extinction threatens to unravel many of the essential ecosystems on which we all depend.3Balmford A Fisher B Mace GM Wilcove DS Balmford B COVID-19: analogues and lessons for tackling the extinction and climate crises.Curr Biol. 2020; (published June 28.) (preprint)https://doi.org/10.1016/j.cub.2020.06.084Summary Full Text Full Text PDF Scopus (10) Google Scholar There are, however, some reasons for cautious optimism. Responses to the COVID-19 pandemic show that nations can act rapidly and radically in response to major immediate threats to health, even at huge economic cost. These actions have generated important co-benefits in terms of reductions in urban air pollution4Watts N Amann M Arnell N et al.The 2019 report of the Lancet Countdown on health and climate change: ensuring that the health of a child born today is not defined by a changing climate.Lancet. 2019; 394: 1836-1878Summary Full Text Full Text PDF PubMed Scopus (887) Google Scholar and carbon dioxide emissions, at least over the short term.6Le Quéré C Jackson RB Jones MW et al.Temporary reduction in daily global CO2 emissions during the COVID-19 forced confinement.Nat Clim Chang. 2020; (published online May 19.)https://doi.org/10.1038/s41558-020-0797-xCrossref Scopus (1431) Google Scholar Maintaining resilience during this pandemic—and those yet to come—will require these and many more long-term changes in patterns of travel, development, and human interactions. As economies open up and lockdowns ease, this resilience will once again be under threat, as will both the environment and population health. It will be even more important to take urgent action on climate change, environmental sustainability, economic policy, and health inequalities.7Institute for Fiscal StudiesThe IFS Deaton review into inequalities in the twenty-first century.https://www.ifs.org.uk/inequality/about-the-review/Date: 2019Date accessed: June 30, 2020Google Scholar, 8HM TreasuryUK GovernmentThe economics of biodiversity: the Dasgupta review: interim report.https://www.gov.uk/government/publications/interim-report-the-dasgupta-review-independent-review-on-the-economics-of-biodiversityDate: April, 2020Date accessed: June 30, 2020Google Scholar, 9Marmot M Allen J Boyce T Goldblatt P Morrison J Health equity in England: the Marmot review 10 years on. Institute of Health Equity, London2020https://www.health.org.uk/publications/reports/the-marmot-review-10-years-onDate accessed: June 30, 2020Google Scholar, 10UK2070 CommissionMake no little plans—acting at scale for a fairer and stronger future.http://uk2070.org.uk/2020/02/26/uk2070-final-report-published/Date: 2020Date accessed: June 30, 2020Google Scholar, 11Swinburn B Kraak VI Allender S et al.The global syndemic of obesity, undernutrition, and climate change: The Lancet Commission report.Lancet. 2019; 393: 791-846Summary Full Text Full Text PDF PubMed Scopus (1474) Google Scholar, 12Masson-Delmotte V, Zhai P, Pörtner H-O, eds. IPCC, 2018: global warming of 1·5°C. An IPCC Special Report on the impacts of global warming of 1·5°C above pre-industrial levels and related global greenhouse gas emission pathways, in the context of strengthening the global response to the threat of climate change, sustainable development, and efforts to eradicate poverty. 2018. https://www.ipcc.ch/sr15/ (accessed June 30, 2020).Google Scholar These three major threats to population and planetary health—communicable diseases, NCDs, and the climate and environmental emergencies—are too often treated as distinct problems, but they are intimately entwined in a global syndemic as reflected in the top global risks identified by the World Economic Forum in 2020.13World Economic ForumThe global risks report 2020.https://www.weforum.org/reports/the-global-risks-report-2020Date: 2020Date accessed: June 30, 2020Google Scholar They possess common underlying causes including unsustainable systems of agriculture, subsidies for harmful products, and overcrowded cities. The transmission of a novel coronavirus from bats to humans might be the dominant model of the genesis of the COVID-19 pandemic, but without urbanisation and global hypermobility it would have spread much more slowly and might have been contained; without high prevalence of NCDs14Caussy C Pattou F Wallet F et al.Prevalence of obesity among adult inpatients with COVID-19 in France.Lancet Diabetes Endocrinol. 2020; 8: 562-564Summary Full Text Full Text PDF PubMed Scopus (180) Google Scholar and air pollution15Wu X Nethery RC Sabath BM Braun D Dominici F Exposure to air pollution and COVID-19 mortality in the United States: a nationwide cross-sectional study.medRxiv. 2020; (published online April 27.) (preprint)https://doi.org/10.1101/2020.04.05.20054502Google Scholar it would have exerted a much lower toll. Breaking the clinical, academic, and policy boundaries that promote separation of these threats demands new ways of understanding and tackling them in order to respond effectively to the combination of the worst pandemic for over a century with the largest economic downturn in modern history. Foregrounding this economic context will be essential for any credible attempt to address these threats. The dominant policy focus for tackling the key behaviours that contribute to NCDs worldwide—unhealthy diets, smoking, alcohol consumption, and physical inactivity—largely ignores the roles of commercial and other non-state actors, publics, policy makers, and others in driving these behaviours.16Kriznik NM Kinmonth AL Ling T Kelly MP Moving beyond individual choice in policies to reduce health inequalities: the integration of dynamic with individual explanations.J Public Health. 2018; 40: 764-775Crossref Scopus (39) Google Scholar As with COVID-19, and climate change and environmental degradation, the drivers and impacts of these behaviours serve to increase the large and growing inequalities in health and wealth within and between countries. In high-income countries, the highest concentrations of tobacco, alcohol, and fast-food outlets are in deprived areas, with consumption increasing with the density of such outlets.17Macdonald L Olsen JR Shortt NK Ellaway A Do "environmental bads" such as alcohol, fast food, tobacco, and gambling outlets cluster and co-locate in more deprived areas in Glasgow City, Scotland?.Health Place. 2018; 51: 224-231Crossref PubMed Scopus (70) Google Scholar As markets in high-income countries become saturated and restricted, so the industries producing and promoting these harmful products find large ready markets in low-income and middle-income countries.18Stuckler D McKee M Ebrahim S Basu S Manufacturing epidemics: the role of global producers in increased consumption of unhealthy commodities including processed foods, alcohol, and tobacco.PLoS Med. 2012; 9e1001235Crossref PubMed Scopus (471) Google Scholar Achieving progress in reversing the global syndemic revealed by COVID-19 requires understanding the common factors that underpin the systems that promote NCDs, communicable diseases, and environmental degradation, the inequalities they fuel, and the levers for effective action across those systems. In response to these challenges, we are establishing The Lancet–Chatham House Commission on population health post COVID-19. This Commission aims to map the shared drivers of pandemic protection, population health, and environmental sustainability as the basis for developing a framework to identify key actions to drive equitable improvements in human and planetary health. It will connect expertise and evidence, including global health, macroeconomics, conservation science, urban design, behavioural and social sciences, building synergies across these—often segregated—domains. We will identify gaps and disjunctions between existing evidence and policies, building the foundations to improve the wellbeing and chances of equitable survival of people and ecosystems. Crucially, the Commissioners will include young people from around the globe to keep the Commission focused on changing our collective trajectory for the generations to come. The COVID-19 pandemic has thrown a harsh light on the failures of global health. Now is the time to rethink the balance between economy, environment, and health, breaking down the barriers between them to improve the wellbeing, and chances of survival, of the global population and the ecosystems within which we all live. This Commission will examine the structures and systems that underpin the behaviours of policy makers, commercial actors, and others who have led us to where we are, and identify practical, pragmatic, and politically achievable steps to guide us towards a healthier and more sustainable future. TMM and HR are Co-chairs of The Lancet–Chatham House Commission. We declare no competing interests. Funding for the Commission is provided as part of a Collaborative Award in Science from Wellcome Trust Behaviour Change by Design: 206853/Z/17/Z; principal investigator is TMM.