Nathan Gardels is the editor-in-chief of Noema Magazine. He is also the co-founder of and a senior adviser to the Berggruen Institute.
If it weren’t for his dogmatic anti-science views on vaccines and pandemics, U.S. Health and Human Services Secretary Robert Kennedy Jr.’s Make America Healthy Again movement would mark a transformative shift in our understanding of health care. At its core, MAHA grasps that placing the onus for being healthy solely on the individual in a sickening environment and a food supply chain contaminated by industrial chemicals is a misplaced responsibility.
How can we be healthy in a sick environment? That is the right question. But answering it entails not a rejection of scientific authority in the name of libertarian politics, but an embrace of science as the path to deeper discovery of how to heal the environment and mend a planet in distress, which are the affective conditions of human health.
This is a perspective laid out in Noema by Nils Gilman, Paul Kortba, Alex Marashian and others. “What if the most salient factors shaping health today lie not within the atomized individual or even their immediate social milieu, but in the fractured, volatile relationship between our species and the Earth system itself?” they ask.
For the authors, the science of salutogenesis, which focuses on the origins of health instead of the origins of disease (pathogenesis), should in our day and age be expanded to the planetary scale.
“Adding the idea of the planetary to salutogenesis isn’t just an effort to insert an ‘environmental’ layer into existing health models,” they write. “It requires a radical revision of how we understand what constitutes collective human health.
“Today’s dominant medical paradigm treats individual personal health as the primary object of concern and relegates the environment to the status of an external variable to be managed or mitigated. Planetary salutogenesis proposes a reversal: that planetary health is the fundamental condition, the enabling context, out of which durable human health, both individual and collective, emerges.”
In this, they follow the thinking of the philosopher Ivan Illich. In his book, “Medical Nemesis,” Illich spoke of “iatrogenic illness” — illness that results from mistreatment by a bureaucracy of physicians who abandoned the ancient idea of health as “balance” within the environment in which a person lived.
As he colorfully related to me in one conversation some years ago at his rustic compound in central Mexico, such a healthy balance could not be achieved by treating the person as a “detached immune system,” apart from their environment and the wholeness of their being, to be managed “from sperm to worm” by the “Brave New Biocracy” of modern medicine.
“An approach to health that is confined to the individual while ignoring this broader context,” the authors write in Noema, “is like carefully tending a wilting flower while ignoring the poisoned soil, acid rain and encroaching desert around it.”
Planetary salutogenesis explicitly acknowledges “the planetary scale of our interconnectedness and predicament. It reframes our approach to health and well-being by contrasting it with the assumptions of individual pathogenesis.”
“Human health,” the authors point out, “is inseparable from the planetary systems we inhabit and constitute. We are not self-contained biological units interacting with a passive external ‘environment.’ Rather, as biologist Scott Gilbert has described, we are holobionts in a vast, interconnected, living web that encompasses microbial, atmospheric, oceanic and terrestrial ecosystems.
“Concepts like the ‘eco-holobiont’ capture this reality of the human organism itself as a complex ecosystem, intrinsically linked to and shaped by its surrounding ecological matrix. Our internal environments mirror our external ones. Soil influences the human gut; fresh air and sunshine impact our physiological functioning; biodiversity affects our immune system and mental health.”
What planetary salutogenesis means in practice is an emphasis on proactively supporting well-being instead of focusing entirely on eliminating disease. As such, it shifts our approach from treatment to prevention, emphasizing the need to confront upstream drivers of ill health — industrial agriculture, fossil fuel dependence, inequitable economic models and anthropocentric worldviews. It also understands that health is relational and emergent, arising from mutualistic, regenerative relationships between humans and the more-than-human world. In short, this perspective is eco-centric, recognizing we are embedded inhabitants in a biodiverse world.
Planetary salutogenesis shifts the focus from genome to exposome, highlighting the critical importance of the totality of environmental exposures (chemical, biological, social, physical) from conception onward — in shaping health trajectories. And finally, in practice this would mean abandoning an economic paradigm obsessed with perpetual growth in favor of an ecological economics that emphasizes the need for balance and recognizes biophysical limits.
These new understandings put personal lifestyle changes as the path to health in perspective. While they may retain ethical and symbolic importance, the authors note that “a planetary lens reveals that true leverage lies in transforming the macro-systems that drive the crisis: energy grids, industrial agriculture, transportation networks, financial markets and consumption patterns. It illuminates the actual scale at which resources — financial, technological, political, social, ecological — must be mobilized and demands met.”
The Make America Healthy Again movement has opened a path toward salutogenesis as a new direction for health care. But just as health care is more environmental than personal, so too is the health of nations a function of the health of the planetary system. Making the Planet Healthy Again is an objective that serves all living beings.
