The Anthropocene related-disease refers to the deep and generalised impact of human activity on the health of people and the planet. Since the mid-twentieth century, this era has been characterised by environmental degradation, climate change, overexploitation of resources and the culture of waste tied to the massive use of fossil fuels. In this context, the chronic diseases involving multiple organs and systems (cardiovascular, renal, respiratory, endocrine, neurodegenerative, malignant…) and emerging pandemics, like the one caused by SARS-CoV-2, are clear manifestations of this environmental crisis. All these diseases share risk factors that are intimately associated with the destruction of ecosystems and modern lifestyles. Approaching them as expressions of the Anthropocene related-disease offers a unique opportunity to integrate human and planet health. If we want to treat the sick among us, we must also cure the planet.

Environmental pollution and climate change have a common origin and share many of its effects with human health. The introduction of the Global Burden of Disease indicator in the evaluation of pollution has succeeded in stirring public opinion and achieved significant advances in its control.3 If we were to implement such an indicator for climate change, it would be possible to join efforts to improve planning and strategies for the protection of human and ecosystem health.

Since 1948, the World Health Organization (WHO) defines health as “a state of complete physical, mental and social well-being and not merely the absence of disease or infirmity.” Although this definition was groundbreaking at the time, today it is often perceived as overly static. We propose a new definition of health based on the “skills” that enable individuals and communities to achieve the optimal physical, mental, and social wellbeing possible “in harmony with Nature.” This definition establishes health as a dynamic and participatory process in which individuals are proactive agents in pursuing their wellbeing, which is tightly associated to the condition of ecosystems. This model will be sustainable and cost-effective only if individuals actively engage in its maintenance and improvement.2

While historical sources of pollution have decreased, the mortality attributable to contaminants such as lead, air pollution and chemicals products has increased drastically.1 The core challenge in this approach is to “renaturalize health” in order to “rehumanize” our practices, restoring the connection of human beings to nature. Rooting child health in this way will give meaning to health care practices and promote a public health model that focuses on protective factors rather than just avoiding risk.

For decades, precision medicine has focused on the human genome, achieving extraordinary advances. However, this approach is insufficient to understand human health as a whole. The challenge for paediatrics in the next 25 years will be to unravel the exposome (the set of environmental exposures across the lifespan) and its impact on well-being. This approach will not only enhance prevention and treatment, but will redefine health care, promoting a more holistic and nuanced perspective. Table 2 summarises the differences between models.2,4

In this new model, primary, secondary and tertiary prevention are unified under an anticipatory approach. The earlier we intervene, the greater the health benefits will be. Anticipation prevents diseases, optimises treatments and improves outcomes by engaging individuals in their own wellbeing (Fig. 1).2

Figure 1.

Anticipatory medicine and targeted prevention practice.

Note: In the Planetary Health model, disease will become a rare phenomenon. Most pediatric activities will focus on early biological alterations or the subclinical phase to prevent the progression to disease.

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Unravelling the exposome through the integration of open data, citizen engagement, and anticipatory action will transform paediatric care. Instead of reacting to disease, anticipatory care will take the helm, enabling the early detection of abnormalities before they become chronic conditions. This shift entails the delivery of most services outside traditional health care facilities. In this future, disease will be a rare occurrence, and health will be largely maintained through the collaboration of health care professionals, educators and society. “Targeted prevention” programmes for risk groups will be at the core of clinical practice and take up a substantial portion of paediatric care resources. Hospitals will be smaller but extraordinarily sophisticated and technologically advanced. This approach will require a redistribution of resources and the establishment of strategic alliances with universities, international institutions, and the private sector, allowing this health care model to transcend the traditional boundaries of medicine and have an impact on global health.2,4

The concept of planetary health proposes a radical integration of human and planetary health. It goes beyond the prevention of diseases, aiming to create environments where children and communities can thrive in harmony with nature. Achieving this goal would require these key actions: (a) to develop new capacities and structures, such as paediatric environmental health specialty units (PEHSUs), which integrate health and environment in clinical practice (the goal would be for each tertiary care/referral paediatrics department in Spain to have a PEHSU by 2030), (b) to establish new professional profiles, such as environmental physicians and nurses, ecotherapists and environmental health technicians and managers, (c) to promote education on environmental health, from before undergraduate education through postgraduate education, to prepare professionals to face environmental health challenges.5

Global and multisectoral action is urgently needed to protect children’s health from the growing harmful effects of pollution and climate change through policies targeting both mitigation and adaptation. These changes will not be easy. Strong opposition from powerful vested interests will have to be overcome. Fortunately, the necessary policies, technological advances, and institutions are already in place to initiate this transformative change. It is only through our collective effort that we will be able to progress towards a more sustainable and equitable model of health, where science, ethics, nature and spirituality converge. As paediatricians, we will not only act as clinicians, but also as community leaders building bridges between medicine, ecology and technology. The active engagement of individuals will be instrumental in co-creating an inclusive, just and resilient model of health for the future of the planet.

Unravelling the exposome is much more than a technical undertaking, it is an act of transformational leadership. As paediatricians, at the forefront of this new era of enlightenment in health, we bear the responsability for building a planetary health system that not only treat diseases but also prevents them and improves their outcomes through environmental protection. This is the time to be bold, to drive meaningful change, and to prepare future generations to live in a world where the health of humans and the health of the planet are inextricably linked.