Beyond political choice: A legal mandate for planetary health in a fractured world
The future state of our planet, and the health of all its living beings, depends on the political choices made by humanity, from the local to the global levels. Profound geopolitical tensions are hampering the international cooperation necessary to protect planetary health, exacerbated by countries – including but not only the United States – retreating from multilateralism, retreating from norms based on shared values of justice, equity and dignity, and retreating from evidence-informed policymaking. These political choices are a formula for instability through conflict, economic uncertainty and disruptions to the Earth’s natural systems. This instability has profound effects on human health, and the resulting fragmentation and isolation are fundamentally incompatible with the urgent cooperation needed to safeguard planetary health.
A planetary health approach to law and governance seeks to distil such cooperation through agreed rules, norms and practices, including in binding law such as treaties, in non-binding but politically persuasive declarations, and even through the interpretation of existing legal obligations, as occurred in the International Court of Justice’s Advisory Opinion on climate change issued this year.
The pervasive impacts of anthropogenic global environmental change on human health are not only scientific realities but also matters of global equity and justice, demanding reform. Infectious disease outbreaks, extreme weather events, heat and conflict are experienced disproportionately across the globe: within countries, systemic discrimination exacerbates environmental health impacts on marginalised populations; and between countries, low- and middle-income countries bear the greatest health burdens while high-income countries continue to benefit from the exploitation of resources contributing to environmental harms. As stated in the report of The Rockefeller Foundation–Lancet Commission on planetary health, these disproportionate injustices are also not temporally constant, with the health of future generations “mortgaged … to realise economic and development gains in the present”.
A legal framework for action
Amidst the many planetary health challenges we face, the ICJ affirmed that climate change is “an existential problem of planetary proportions that imperils all forms of life”, underscoring the World Health Organization’s statement that it is the greatest threat to global health in the 21st century. In advising on the nature of legal obligations with respect to climate change, the ICJ identified international human rights law, including the rights to health and life, as well as the right to a clean, healthy and sustainable environment, noting their inextricable interdependence on each other and the state of the Earth’s climate and ecosystems.
Although not legally binding, the impact of the ICJ advisory opinion is likely to be profound. By clarifying international legal obligations, it can empower civil society, advocates and communities to hold countries accountable to their international legal commitments. It has the potential to be highly persuasive in domestic litigation in several contexts, while providing momentum for political action at international forums such as the 30th Conference of Parties to the United Nations Framework Convention on Climate Change in Brazil in November 2025.
Developments in other global spaces have also reflected planetary health approaches that move away from traditionally siloed human health. At the 78th World Health Assembly this year, WHO member states adopted the Pandemic Agreement after more than three years of negotiations. This landmark treaty seeks to prevent, prepare for and respond to pandemics, and enshrines the principle of One Health – that human, animal and environmental health are interconnected – into a legally binding treaty for the first time. This interconnection is further realised through the express incorporation of obligations to take measures to identify and address the upstream drivers of infectious disease at the human, animal and environmental interfaces. The agreement also recognises the role of environmental and climatic factors in increasing the risk of pandemics, with parties endeavouring to include these considerations in national, regional and international policymaking.
Critical challenges, crucial milestones
The agreement has some time before taking legal effect, with opening the agreement for signature conditional on the successful negotiation of an annex for pathogen access and benefits sharing currently underway. Then, countries will be faced with the choice of whether to sign, ratify and become parties to this new legally binding instrument. That choice before political leaders will determine the health of all of us in the next pandemic.
These two 2025 global governance milestones have a clear message: health is a political choice. This is a significant shift from the traditional and siloed approaches to planetary health issues. It is a movement towards laws and policies that better reflect a complex but not unnavigable scientific reality.
However, critical challenges remain. These legal victories need to be translated into tangible action, with clear policy and budgetary commitments, particularly at the national level. Solidarity across countries will be integral to protecting civil society, healthcare and legal professionals, and scientists operating in oppressive settings. Pollyannaism and defeatism are equally destructive to demanding and achieving accountability for political choices that harm health. Planetary health reminds us to choose cooperation over fragmentation, long-term sustainability over short-term gains and evidence-informed action over disinformation.
Despite significant obstacles to leaders making planetary health choices in the future, good governance, the enforcement of laws and policy accountability are critical tools for advocates and professionals. It is precisely during its contravention that upholding the principle of the rule of law is most vital, and safeguarding health is the only viable political choice.
