EDITO RIA L
emergence of new diseases and pandemics (Dunne, 2022 ). People losing contact with the natural environment and the decline loss in biodiversity have both been linked to increases in noncommunica- ble, autoimmune and inflammatory diseases and metabolic, allergic and neuropsychiatric disorders (Altveş et al., 2020 ; WHO and the Secretariat of the Convention on Biological Diversity, 2015 ). For Indigenous people, caring for and connection with nature is espe- cially important for their health (Schultz & Cairney, 2017 ). Nature has also been an important source of medicines, and thus reduced diversity also constrains the discovery of new medicines. Communities are healthier if they have access to high-quality
green spaces that help filter air pollution, reduce air and ground tem- peratures and provide opportunities for physical activity (MacGuire et al., 2022 ). Connection with nature reduces stress, loneliness and depression, while promoting social interaction (Wong et al., 2018 ). These benefits are threatened by the continuing rise in urbanisation (Simkin et al., 2022 ). Finally, the health impacts of climate change and biodiversity
loss will be experienced unequally between and within countries, with the most vulnerable communities often bearing the highest burden (WHO and the Secretariat of the Convention on Biological Diversity, 2015 ). Linked to this, inequality is also arguably fuelling these environmental crises. Environmental challenges and social/ health inequities are challenges that share drivers and there are po- tential co-benefits of addressing them (WHO and the Secretariat of the Convention on Biological Diversity, 2015 ).
A GLOBAL HEALTH EMERGENCY
In December 2022, the biodiversity COP agreed on the effective conservation and management of at least 30% of the world ' s land, coastal areas and oceans by 2030 (Secretariat of the Convention on Biological Diversity, 2022 ). Industrialised countries agreed to mo- bilise $30 billion per year to support developing nations to do so (Secretariat of the Convention on Biological Diversity, 2022 ). These agreements echo promises made at climate COPs. Yet many commitments made at COPs have not been met. This
has allowed ecosystems to be pushed further to the brink, greatly increasing the risk of arriving at ‘tipping points’, abrupt breakdowns in the functioning of nature (Armstrong McKay et al., 2022 ; Ripple et al., 2023 ). If these events were to occur, the impacts on health would be globally catastrophic. This risk, combined with the severe impacts on health already
occurring, means that the World Health Organization should declare the indivisible climate and nature crisis as a global health emergency. The three pre-conditions for WHO to declare a situation to be a Public Health Emergency of International Concern (WHO, 2005 ) are that it: (1) is serious, sudden, unusual or unexpected; (2) carries implications for public health beyond the affected State ' s national border; and (3) may require immediate international action. Climate change would appear to fulfil all of those conditions. While the ac- celerating climate change and loss of biodiversity are not sudden
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or unexpected, they are certainly serious and unusual. Hence, we call for WHO to make this declaration before or at the 77th World Health Assembly in May 2024. Tackling this emergency requires the COP processes to be har-
monised. As a first step, the respective conventions must push for better integration of national climate plans with biodiversity equiva- lents (European Academies Science Advisory Council, 2021 ). As the 2020 workshop that brought climate and nature scientists together concluded,
‘Critical leverage points include exploring alternative
visions of good quality of life, rethinking consumption and waste, shifting values related to the human-nature relationship, reducing inequalities, and promoting education and learning’ (Otto-Portner et al., 2021 ). All of these would benefit health. Health professionals must be powerful advocates for both re-
storing biodiversity and tackling climate change for the good of health. Political leaders must recognise both the severe threats to health from the planetary crisis as well as the benefits that can flow to health from tackling the crisis (Consultation on Australia ' s first National Health and Climate Strategy, 2023 ). But first, we must rec- ognise this crisis for what it is: a global health emergency.
Kamran Abbasi 1 Parveen Ali 2
Virginia Barbour 3 Thomas Benfield 4
Kirsten Bibbins-Domingo 5 Stephen Hancocks 6 Richard Horton 7
Laurie Laybourn-Langton 8 Robert Mash 9 Peush Sahni 10
Wadeia Mohammad Sharief 11 Abdullah Shehab 12 Paul Yonga 13
Chris Zielinski 14 1 BMJ
2 International Nursing Review 3 Medical Journal of Australia 4 Danish Medical Journal 5 JAMA
6 British Dental Journal 7 The Lancet
8 University of Exeter
9 African Journal of Primary Health Care and Family Medicine 10 National Medical Journal of India 11 Dubai Medical Journal
12 New Emirates Medical Journal 13 East African Medical Journal 14 University of Winchester
Correspondence: Chris Zielinski Email:
chris.zielinski@ukhealthalliance.org
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