by Rachael Marsh
Public Health resident, Bristol, UK

“We can only pray that our sick planetary patient might be placed on a road to recovery – failure to write the prescription, however, might leave us contemplating the death certificate instead”. Prince of Wales 2015, Royal Society in London.

Our Planet is Critically Sick

If we were to consider our Planet as a patient, as health professionals, we would be seriously concerned about their health and would quickly diagnose that ‘Patient Planet’ was critically sick. A rapid assessment of the Planet’s health
would find an escalating fever, with difficulties breathing, a faltering circulation, with metabolic acidosis and a toxic status, failing liver and kidney functions, a pale, blotchy skin indicating signs of shock, with a rapidly declining mental state.
Human systems can be seen as a microcosm of the Earth’s living biosphere, although there are significant differences in scale and functioning of some of these systems, in terms of appreciating the seriousness of the Earth’s failing eco-systems, it is helpful to consider the analogies of the Planet’s health with that of a human, as below:

“Fever – escalating temperature – 1°C now, rapidly rising to 3-4°C by 2100 and 3-10°C by 2200 (a temperature rise of 3-4°C is considered a medical emergency and risks fatally in humans).
Respiratory System – escalating carbon emissions with CO2 at 411ppm; air pollution dangerously high with 91% of places exceeding WHO guidelines; wildfires and continued loss of global forests.
Circulatory system – oceans 30% increased acidity having absorbed 50% of postindustrial carbon emissions and 90% of the excess heat (equivalent to 36°C when released back to the atmosphere); pollution with toxins and plastics; freshwater scarcity.
Organs (liver and kidneys) – an annual 3% loss of swamp and marsh lands that protect coasts, detoxify and regenerate.
Skin – increasing desertification, mudslides, and depleted agricultural land.
Mental Health – biodiversity loss at 60% for mammals, birds, fish and reptiles since 1970, nearing the threshold for a sixth mass extinction at 75% loss.”

Source. IPCC (2018); WHO (2016); NASA (2019); FAO (2019); WMO (2019); Living Planet Report (2018); IUCN (2016); Drawdown (2017); Lewis and Maslin (2018); Kumar and Clark (2016).

Diagnosis and prognosis – will ‘Patient Planet’ die?

As physicians, we would diagnose an escalating fever with a critical risk of multiple organ failure and send ‘Patient Planet’ straight to Critical Care. Not knowing what else to do, we could declare the situation as chronic, terminal, and just take steps to make the patient as comfortable as possible until the end came. However, we stand at a critical moment in the history of our Planet. Over the next decade, we are the generation that holds the responsibility to reverse the epidemic explosion of carbon emissions and urgently stabilise the risks from runaway climate change.

Management – how can we save ‘Patient Planet’?

Just like for a sick patient, by taking a Critical Care Response approach as below, we can halt and potentially reverse the harm done so far.

Resuscitation: declare a Climate Emergency.
We already have mechanisms like the WHO Emergency Response Framework in place, and given the critical state of the Planet’s Health, this should warrant an urgent assessment, which based upon risks and severity of global impacts, should be placed at Grade 3, triggering a multi-sector, global emergency response (WHO, 2017). We can draw lessons from handling other emergencies like Ebola, which led to rapid mobilisation of resources, strategic co-ordination and action at speed and scale.
Stabilization: homeostasis/ re-stabilization of systems requires a rapid reduction of carbon emissions over the next decade, including actively sequestering carbon to lower the driver of increasing temperatures. Stabilisation
of ocean temperatures and acidity may also be required.
Treatment: depending upon the successful resuscitation and stabilisation, ‘Patient Planet’ would be able to leave the critical care unit, with a longer-term treatment plan, including an initial recovery period, during which time
toxins and plastics would be removed to allow healing.

Recovery: to enhance the recovery of ecosystems
Air – rapid investment in clean energy and transport systems
Water – restore healthy ocean and coastal environments, enhance naturebased solutions for clean water and
sanitation systems
Food – reduce food waste and excess consumption, enhance plant based healthy foods and clean cooking
Rehabilitation: additionally, a preventive approach would be taken, including building climate resilience/ emergency preparedness (flood management, drought response, etc). Development of planetary health indicators to
act as an Early Warning Score enabling detection of high-risk symptoms, and corresponding early intervention.
Promotion: promote sustainable development with a focus on actions that primarily benefit the health of the Planet, whilst maximising cobenefits for humans, including: continuing work towards the Sustainable Development Goals (SDGs, 2015) and actions such as; reduced food waste, plant rich diets, family planning, educating girls, clean cookstoves, renewable energy, housing insulation, recycling, forest protection, water saving, walkable cities, and
cycling infrastructure (Drawdown, 2017).
The UN recently declared that we have to reduce global carbon emissions by 45% by 2030, in order to keep to within safe limits (1.5°C), with a target of zero emissions by 2050. This requires urgent, large-scale action with an estimated annual investment of 2.5% of global GDP (IPCC 2018).

Please share this analogy widely to help save ‘Patient Planet’. Concept adapted from work by Dr Joanna Nurse
(Strategic Advisor to InterAction Council).


Drawdown, (2017) ‘The most comprehensive plan ever proposed to reverse global warming’ edited by Paul Hawken, Penguin.
FAO (2019) ‘The State of the World’s Biodiversity – for Food and Agriculture’
IPCC (2018) ‘Global Warming of I.5C’ Intergovernmental Panel on Climate Change;
IUCN (2016) ‘Explaining Ocean Warming – causes, scale, effects and consequences’
Kumar and Clark (2016) ‘Clinical Medicine’ 9th Edition, Elsevier.
Lewis SL and Maslin MA (2018) ‘The Human Planet – How We Created the Anthropocene’ Pelican, Penguin Random House UK;
Living Planet Report, (2018) “Aiming Higher” World Wildlife Fund: files/2018-10/wwfintl_livingplanet_full.pdf
NASA (2019) Carbon Dioxide Vital Signs:
Stockholm Resilience Centre, (2018) Hothouse Earth Scenario:
SDGs (2015) ‘Sustainable Development Goals’ United Nations
WHO (2016) ‘Ambient Air Pollution – a Global Assessment of Exposure and Burden of Disease’
WHO (2017) ‘Emergency Response Framework’;jsessionid=3B3D33D3A90B88252DBB9FBF840F0705?sequence=1
WMO (2019) ‘Statement on the State of the Global Climate in 2018: