Paradigm Worker

clay model of adult human form in fetal position overlaid on blue marble photograph of the Earth from space on a black background
Integrated planetary health image collage - Jonee Kulman Brigham

Planetary Health

Naming the Goal, Naming the Patient

July 1, 2020

By: Jonee Kulman Brigham

The June column from Paradigm Worker, a place for monthly reflections on how we think about things, and why it matters.

Planetary Health

Naming the Goal, Naming the Patient

All the major disruptions to our old normal seem designed to convince us we are within the transition to a new era. Are we like the caterpillar in the chrysalis, where prior forms are dissolving and we are disintegrating into a liquid soup before we emerge in a new winged form? It would be nice to think we were in such a metaphor and guaranteed to emerge as a butterfly. But our story may be more of ‘what doesn’t kill us will make us stronger.’ We may not survive beautifully if at all, or at least we can’t tell yet. As a designer, I like to think of shaping the future, not just predicting it. Humans are a designerly species--ever eager to alter our environment to improve the condition of ourselves and our community. Naming what we don’t want has a place in design but it is in imagining what we do want that drives innovation and betterment. A well-guided design has a vision of a desired state and/or a desired way to proceed. Coming from the health professions, one possible name for a design goal at the global scale is “planetary health.”

Naming the Goal

It may be hubris to think of planetary design, and we may have been better off if we left natural systems more to themselves. But we already design at a planetary scale, even if we do it unconsciously. We have blindly designed ourselves into what some call the Anthropocene – a state of the planet dominated by human interventions. We may not have intended to alter global systems, but that is the end result of all the parts we’ve altered. We need to acknowledge the scale of our influence and go beyond designing our influence in bits and pieces–-optimizing a concrete product flow here, and optimizing international agriculture there. All these industrial processes add up to larger system behaviors we didn’t intend, which extend us beyond planetary boundaries for systems such as biochemical flows, biosphere integrity, and climate change.

Science on planetary boundaries is in some ways supporting design at a planetary scale, for example the efforts to coordinate responses to address climate change. Solutions-focused science like Project Drawdown identify technologies and policies to address climate change. One of the powerful aspects of Project Drawdown, is its name which defines the destination. They define drawdown as, “the point in the future when levels of greenhouse gases in the atmosphere stop climbing and start to steadily decline.” The name “Project Drawdown” makes a good story- it names the heroes’ quest. And a clear quest is a good driver for design. Like the concept of drawdown, ‘planetary health’ could name a destination in positive terms, though it isn’t clear if it is being used that way in all the groups adopting the name.

Naming the Patient

Planetary health is not a singular movement, though there are prominent groups of actors. While I am a new explorer of planetary health, what I have found so far is that at its core, the concept of planetary health recognizes the interdependence of human health and the state of the world’s eco systems. To Indigenous Peoples this is nothing new. Some of the roots of the concept from the health fields, include Norwegian physician Per Fugelli’s 1993 statement that “The patient Earth is sick. Global environmental disruptions can have serious consequences for human health. It's time for doctors to give a world diagnosis and advise on treatment.” Founded in 2016, The Planetary Health Alliance, may be one of the most prominent voices for planetary health. They are a worldwide consortium of universities, research institutes, NGOs, and governmental organizations. They describe planetary health as, “a field focused on characterizing the human health impacts of human-caused disruptions of Earth's natural systems.” While both statements about planetary health have interconnected health in common, they are quite different in their emphasis. Fugelli’s concept of “patient Earth” invokes patient care narratives and responsibility to Earth systems in a primary way. In contrast, the Planetary Health Alliance language takes a more utilitarian approach to natural systems which are valuable to the extent that they support human health. This parallels the way the field of environmental health is concerned with the effect of the environment on human health – not the health of the environment itself. As expressed on the Planetary Health Alliance website, it seems the patient is humanity, not the Earth.

What is appealing to me about the name (and invitation to paradigms) of “Planetary Health” is that it could be a design goal with the potential for a unified and cooperative model of well-being along the lines of Fugelli’s conception. If there is a ‘patient Earth,’ then the well-being of humans which are part of the Earth system, is intertwined with the planet’s well-being. This approach to Planetary Health would represent both an aspiration to integrated health work and the science-supported reality of our intertwined destiny.

Clarifying the community of concern who is the ‘patient’ is critical. In the abstract, it may not matter to desired results whether some humans care for the zebra because it ultimately affects their own health, or if they care for the zebra as a fellow member of Earth’s life community. But in application, we will face trade-offs between members of Earth’s life systems, and the paradigms for the planetary health movement will affect how we make those choices. Thus, the secondary questions of why we aim at planetary health, what we mean by it, and which life forms it aims to serve will clarify the paradigm and make it a stronger basis for designing solutions.

Paradigm Work for Planetary Health

In fall of 2019, I was invited to an interdisciplinary discussion about planetary health at the Institute on the Environment at the University of Minnesota. Teddie Potter, Director of Planetary Health at the University’s school of Nursing, coordinated the panel. I don’t work in the health fields, but I am interested in the role of paradigms in systemic change and so I presented work on human-nature paradigms as a context for planetary health and posed some questions to prompt discussion.

Paradigm Questions for Planetary Health

  • Is planetary health primarily an instrument for human health, or is health of the planet of inherent importance in itself?

  • Is the planet our health clinic? Is it a utilitarian container for human well-being? Do we live ON/IN Earth? Or are we PART OF Earth?

  • Is the planet our larger body? – An exo-body, integrally linked with our health, as our own flesh? Can we have a “planet-ache?”

  • Are we one of the planet’s organs or microbiome? Can we have a planet-centered health, with humans as a functioning part of a larger organism; of a “Gaia?” Does Gaia have a human-ache?

  • Who leads planetary health care? Earth? Humans? Jointly? Where does knowledge lie?

  • Who defines health and its extents? (Physical, social, spiritual, economic)

  • How many models of health or how many stories are sought? How do we transcend single paradigms?

The purpose of the questions is not to solve a vision of planetary health in absolute terms. As a paradigm it is an evolving design strategy for a story of how to thrive on Earth and what life forms are members of our community of concern, and why. The answers matter. Without a clear vision of what planetary health means, we won’t know how to guide decisions, and will fall back on default paradigms we already know are flawed. To be intentional about our planetary design, we need to visualize and clarify what success looks like. We have some control over how we emerge from the disintegrating state of societal and Earth systems. What will we envision?



Casassus, Barbara. “Per Fugelli.” The Lancet, vol. 390, no. 10107, Elsevier, Nov. 2017, p. 2032., doi:10.1016/S0140-6736(17)32737-X.

Definitions of Environmental Health | National Environmental Health Association: NEHA. Accessed 30 June 2020. “Planetary Health Alliance, Mission.” Planetary Health Alliance., Accessed 30 June 2020.

---. “Planetary Health Alliance, PLANETARY HEALTH.” Planetary Health Alliance., Accessed 30 June 2020.

Project Drawdown. Accessed 1 July 2020.

Seltenrich, Nate. “Down to Earth: The Emerging Field of Planetary Health.” Environmental Health Perspectives, vol. 126, no. 7, July 2018. PubMed Central, doi:10.1289/EHP2374.

Steffen, Will, et al. “Planetary Boundaries: Guiding Human Development on a Changing Planet.” Science, vol. 347, no. 6223, Feb. 2015, p. 1259855., doi:10.1126/science.1259855.

©Jonee Kulman Brigham