People-Planet-Health: promoting grassroots movements through participatory co-production

Abstract

The threat of anthropogenic climate change demands immediate action to prevent further damage to human health and fragile natural ecosystems. This process of change might locally have already begun, led by grassroots organisations around the world. Conceiving their actions as a form of salutogenesis, these organisations build a Sense of Coherence to empower communities to participate in the potentially overwhelming challenge of planetary health. People-Planet-Health aims at giving voice and visibility to those groups and their actions. Contributors will further be invited to co-create a position paper, to inform the revised WHO Global Strategy for Health Promotion.

Anthropogenic climate change threatens health by degrading ecosystems on which human life is dependent (1). Rising temperatures, species extinction, zoonoses, and other aversive effects of the Anthropocene increase health risks, causing direct damage to human health through migration, malnutrition, new epidemics and psychological stressors associated with overwhelming change (2). It is estimated that ‘globally, 23% of total deaths could be prevented through healthier environments’ (3). Numerous legislative actions taken at national and supranational levels have provided populations with aspirations for sustainable development, but have not realised the systematic change required to generate measurable improvements in human health or protection of ecosystems. In this sense, top–down approaches to climate change mitigation have thus far failed to build capacity for change.

However, the process of sustainability innovation has already begun, through the actions of grassroots activists around the world. This commentary draws attention to the work of grassroots groups, to reframe planetary health as a global salutogenic process of change. Recognising both the willingness and potential presented by these groups in bringing about planetary health, but also the barriers they face in conducting, upscaling and coordinating their work, we call on health promotion practitioners to support grassroots actions, contributing to a participatory process of planetary salutogenesis. The commentary further invites participation in People-Planet-Health: a novel knowledge exchange initiative giving voice and visibility to those groups through global co-production of a position statement on planetary health, to inform policy development activity of the World Health Organization.

Planetary health

Threats to human health and the vitality of ecosystems, by climate change, are inextricably linked, demanding new discourses concerning health in the Anthropocene (4). Characterised as the ‘new science for exceptional action’ (5), planetary health is a holistic conception of wellbeing, assuming human and environmental interdependence. Viewing humans as custodians of ecosystems, and ecosystems as providers of essential resources for human wellbeing, planetary health challenges anthropocentric discourses on sustainability, re-centring the earth as a living material on which life is dependent (6). This reconceptualisation is already happening at a grassroots level and can be explored through a salutogenic lens.

The salutogenic approach to planetary health

The theoretical framework we propose is the theory of salutogenesis, proposed by medical sociologist Aaron Antonovsky. Salutogenesis focuses on how health may be created, maintained, and restored, defining health not as a normative-static state, but as a learning process, on a continuum between the poles of health-ease and health-disease. Individual experiences responding to life stressors influence the direction of movement between these poles. If stressors can be successfully addressed, a movement towards health-ease is achieved. Without this, tensions occur which may bring about movement towards health-disease. Movement along the continuum depends on the resources that can be accessed to cope with demands, and Sense of Coherence (SOC). Antonovsky (7) defined the concept of SOC as a global orientation that expresses the extent to which one has persuasive, enduring, though dynamic feelings of confidence concerning:

• - Sense of Comprehensibility: that requirements from one’s internal and external environments are structured, predictable, and explicable.

• - Sense of Manageability: that resources are readily available and accessible for one to meet these requirements.

• - Sense of Meaningfulness: that the challenge of meeting requirements is worthy of investment and active engagement.

Sense of Coherence is measured by SOC scales and has been proven to predict and explain physical and mental health, as well as health behaviour and the management of various conditions (8). A strong SOC is congruent with improved wellbeing, ability to access and create resources, and coping with acute and chronic stress (9). In salutogenic theory, health is created from interactions between resources and environments, in a lifelong learning process that ideally leads to a movement towards health-ease. This corresponds to recent sociological theories of new materialism that underpin current developments in theoretical frameworks for planetary health. Fox and Alldred (10) state that health is never an outcome but rather a process of ‘becoming-healthy’, or ‘healthing’ not only of individuals but of assemblages of individual-environmental entities. Considering theoretical congruence of these ideas, we conceptualise planetary health as progressing beyond normative anthropocentric discourses of health, towards a learning process of interactions between populations and environments that are valued as equal, interdependent entities. This process may be understood as ‘planetary salutogenesis’: creating and maintaining both the sustainability of natural ecosystems and human wellbeing through strengthened Sense of Coherence, and novel relationships with resources.

Planetary salutogenesis through grassroots activism

Across the globe, local grassroots initiatives are undertaking actions directed towards sustainability and planetary health. These groups do not value the environment as an object to be influenced, owned or shaped, but rather understand it as a co-environment with which they interact in the interest of commanding greater quality of life for local people, and continued vitality of ecosystems. Thereby, they act according to the principles that theories of new materialism and salutogenesis propose: by ‘healthing’ with consideration for sustainability, the groups build and strengthen Sense of Coherence.

• - They translate overwhelming, enormous planetary threats into local projects, giving them context that empowers people to take action to solve those challenges (Sense of Comprehensibility).

• - They provide a tangible base upon which to act, by innovating physical solutions through which people can gain a sense of control (Sense of Manageability).

• - They give the challenges local significance, motivating people to engage and address global threats in ways which speak to their local interests (Sense of Meaningfulness).

In creating Sense of Coherence (SOC), the initiatives create human health, as SOC is a predictor and indicator of the physical and mental health of individuals and groups (11). The initiatives have multiple relevances for health promotion. Strengthening SOC, they act as a buffer for environmental stress, and create both immediate and ongoing benefit for the individuals involved. Although their impact on sustainability indicators is typically unmeasured, the grassroots initiatives contribute to planetary health by forming new, tangible linkages between previously disparate concepts, such as sexual health, sustainable consumption, eco-friendly housing, food waste, quality of healthcare, and other challenges. Some examples of these linkages that promote planetary salutogenesis represent diverse global geographies and topical interests.

• - The Uganda Youth and Adolescence Health Forum has developed participatory approaches connecting reproductive and planetary health. Amongst many diverse empowerment activities, the project leaders describe the impact of poverty on access to sanitary pads, and the subsequent effect this has on girls’ early school dropout rates. ‘We believe that women can be agents of change in their communities and have engaged them in more sustainable and environmentally friendly measures towards addressing their sexual and reproductive health. For example, we train young women and girls in the making and use of reusable sanitary pads which are made from environmentally friendly and biodegradable materials.’ The organisation hopes to deliver more sustainable health promotion programmes that illustrate intergenerational links between climate change, other health risks, and reproductive health.

• - Sustanarea, an initiative in Brazil, is a University Extension Program of the School of Public Health at the University of São Paulo. Its objective is to improve accessibility to, and normalisation of sustainable diets for the Brazilian population. It does this through promotion of dietary behaviour change, by reducing red and processed meat consumption, encouraging increased fruit and vegetable consumption, reducing purchasing of ultra-processed foods, and advocating production of food with minimal environmental impact. The group engages in capacity-building for planetary health, via co-production of projects between public health academics and local communities in urban São Paulo.

• - In Sri Lanka, the Goodness Foundation focuses on activities centred around the empowerment of individuals and communities in disadvantaged regions, by delivering a holistic programme of sustainable housing, school supply packs for disadvantaged children, and medical and dental care to 180,000 rural villagers. The organisation also runs sustainable business training in disadvantaged rural areas. Sharing their vision, the project leaders stated: ‘Sustainable development and the concept of planetary health should embrace traditional ways of living that draws on generations of local knowledge to live in harmony with nature while maintaining good long-term quality of life.’

• - The volunteers of the Real Junk Food Project Central, in the UK, prepare meals from edible ‘waste’ food from supermarkets and wholesalers, and distribute them through their inclusive community cafes in economically deprived urban areas. Customers are invited to ‘Pay As You Feel’ for their food, and payment is accepted in ‘time, cash, skills, or imagination’, referring to the initiative’s use of asset-based approaches and their holistic valuation of material in community development. The project has saved approximately 300 tonnes of edible food since its founding in 2017, and has used it to produce nearly 600,000 meals.

People-Planet-Health

Launched in July 2020, the People-Planet-Health programme aims to give voice and visibility to these groups and their work, while encouraging them to share their actions, thereby supporting capacity-building within and between grassroots initiatives. People-Planet-Health, initiated by the first and the second authors, is supported by Lucerne University of Applied Sciences and Arts and conducted in partnership between Lucerne University, the University of Nottingham, and the International Union of Health Promotion and Education. In this project, groups undertaking grassroots activities are invited to share short stories about their work towards, and vision of, planetary health. With respect for the dynamic, organic, and unique cultures of grassroots movements, initiatives are personally contacted, or may join through word of mouth. This process is facilitated by Planetary Health Officers, who – as health promotion students – are familiar with both the concept of grassroots activity and the visions of health-promoting organisations.

The initiatives are asked to describe what they do, what they intend to achieve, and how their visions of planetary health can be realised, submitting their short descriptions in eight languages. Aligned with Antonovsky’s open framework for SOC, and Fox’s flexible materialist conception of ‘healthing’, initiatives are welcomed to share their contributions following a simple self-audit of their actions according to salutogenic principles. The stories contributed are featured on a website and social media platforms, sharing examples of grassroots activity and their relevance to planetary health.

At the beginning of 2021, grassroots initiatives from all inhabited continents had joined the programme. Their topics and objectives cover a wide range of initiatives tackling food waste, sexual health, health networking, knowledge exchange, sustainable entrepreneurship, environmental education, and many others. The aforementioned examples give insight on what can be further read on the programme website (12). A second stage, initiated in June 2021, invites contributing initiatives to co-create a position statement to inform the revised WHO Global Strategy for Health Promotion.

A healthier future: policy and practice

As the leaders of the Te Whare Hauora o Te Aitanga A Hauiti project (Aotearoa) state: ‘The future of sustainable well-being for people and the planet, as evidenced by the chaotic international response to the COVID-19 pandemic, is unachievable without the establishment of a world commonwealth in which all nations are in agreement, and in which the autonomy of its state members and the personal freedom and initiative of the individuals that compose them are safeguarded’ (12). Health promotion must support realignment of human connections with the environment, by conceiving of new ways in which sustainable activity might take place, not only around humans, but as humans being part of the process. We conceive of this as the outcome of planetary salutogenesis, and call upon the health promotion community to support grassroots groups to progress their actions towards it, particularly in reference to accessing resources, measuring impact and upscaling their activity. How this might be achieved will be the central focus of the second phase of the People-Planet-Heath project. In a common participatory writing and discussion process, all projects participating were invited to co-create a position statement for the new WHO Health Promotion Strategy that will be more than just the sum of the involved projects: it will create new insights, in a novel way, from the cooperation of a global yet local network of grassroots groups. The position statement will serve as an initial participatory global framework for supporting and promoting the process of planetary salutogenesis, calling upon health promotion practitioners and global policymakers to value grassroots contributions in the creation of planetary health.