The concept of co-benefits provides a conceptual tool that makes human (and their health’s) dependence on ecosystems tangible, by linking the short- and long-term benefits that come with reducing environmental degradation to tangible short-term effects on public health. This concept-tool could thus encourage individual behavioral changes as well as the implementation of structural measures, with the goal of providing two-fold benefits: improving individual and population health and reducing environmental degradation. It is of course not a matter of entertaining dualism by differentiating human benefits, on the one hand, from benefits to the natural environment, on the other. As mentioned in the introduction, since humans depend on their environment, the environmental benefit of an action that is geared towards improving human health also often causes indirect benefits for humans – it is therefore dually beneficial to health, rather than a co-benefit that helps only the environment. For instance, reducing greenhouse gas emissions by encouraging active mobility over car use has a doubly positive health effect: there is the benefit of the physical activity on the user, and the reduction of risks related to global warming for the population.
By tying environmental issues to health questions, the concept of co-benefits encourages the costs and benefits of individual or societal actions to by systemically taken into account for the individuals directly concerned, their communities and the environment, both present and future, here and on the other end of the planet. Coupled with better recognition of the major risks to health that stem from the profound degradation of ecosystems that is being observed around the world, this concept provides an opportunity, among others, for health services to play a key role in the implementation of structural measures and individual behavioral changes in the struggle against environmental degradation.11,16,19,20,25 In this sense, clinical practi-tioner recommendations could be connected to regional governance measures, to encourage changes in certain lifestyle habits.
Planetary limits establish a strict framework that should limit human activity. Slowing the pace of the erosion of biodiversity and reaching carbon neutrality require deep and systemic changes to our lifestyles, particularly when it comes to farming and food, as well as to mobility. These changes will need to be based on a new or renewed relationship with nature, by recognizing the biosphere’s ecological limits and human dependency on ecosystems.
As J. Baird Callicott notes: “Human activity should at least be compatible with the ecological health of the natural environment in which it takes place. Ideally, it should enrich it.”143 Yet it is a known fact that the current pre-dominant economic model, including within health services, which is centered around a logic of productivity and short-term yields, is incompatible with a sustainable vision of ecosystems and of our societies.144 The pressures of planetary limits thus pose a challenge to all human activities, including medical practices: if human health depends on respecting the biosphere’s limit, how do we improve human health without contributing to environmental degradation? How should health be defined and how should health services be designed within a framework that fits strictly into these planetary limits?145.146
The concept of co-benefits offers a promis-ing approach, but further research is needed to make it a real path towards the future, as well as to gain a better understanding of what interventions would be most effective, and what types of actions to favor, based on the geographic and socioeconomic contexts of patients and individuals. What is more, gaining a better understanding of how different areas of intervention can work in relation to one another could also contribute to mutually strengthening them. This was seen in the case of community gardens, which naturally link questions of food and contact with nature. Similarly, mobility is closely tied to questions of territorial planning. For instance, by reallocating a portion of the public space that is currently devoted to parking spaces, more green spaces or urban gardens could see the light of day (figure 10).
The intersection of interventions on individual levels and structural levels (legislation, infrastructure, social norms…) must be well thought out, in a way that guarantees the effectiveness of those interventions. The effectiveness of promoting certain behaviors is largely limited if structural frameworks and social norms do not also encourage those behaviors. For instance, recommending that people eat less meat, or ride a bike on their daily commutes, are hard to follow if there are no vegetarian options in institutional catering establishments, or if the available cycling infrastructure isn’t seen as safe and continuous. The question thus comes up of the role of advocates that health workers and services ought to play to encourage, in an interdisciplinary fashion, communities to take planetary limits more into account, both at the micro and macro level. This is particularly true for primary caregivers, who will need to play an active role in the local communities they serve.