Planetary Health: Capitalism, Ecology and Eco-Socialism

ABSTRACT

Adopting a critical anthropology of health perspective, informed by political ecology, we examine planetary health in the era of late capitalism or neoliberalism. The shift to a planetary health thinking was driven by the growing awareness that not only are all human communities now multiply linked together by flows of commodities, ideas, people, and health-related influences from vectors to medicines, but that the health of human communities is multiply linked to the environment including other species within us (e.g. gut flora) and around us. Within the planetary health framework, we focus specifically on both emerging and re-emerging infectious diseases, particularly the COVID-19 pandemic, and the growing impact of anthropogenic climate change on health.

While poorer regions of the world need economic development, that is, access to basic resources and health care, much of the developed world and parts of the developing world are, in a sense, overdeveloped. Perhaps more than any other issue, the ecological crisis, which includes catastrophic climate change allows critical scholars to contemplate the contradictions of the capitalist world system, including its implications for health, and to ponder the creation of an alternative world system, namely eco-socialism.

KEYWORDS:

• Capitalism
• metabolic rift
• infectious diseases
• climate change
• eco-socialism

Introduction

Adopting a critical anthropology of health perspective, informed by political ecology, this article examines planetary health, particularly in the era of late capitalism or neoliberalism. Planetary health has been defined as “the achievement of the highest attainable standard of health, wellbeing, and equity worldwide through judicious attention to the human systems – political, economic, and social – that shape the future of humanity and the Earth’s natural systems that define the safe environmental limits within which humanity can flourish” (Whitmee et al. 2015). Planetary health explicitly recognises the significance of “natural systems in terms of averted cases of disease and potential harm that comes from human-caused perturbations of these systems” (Seltenrich 2018, [1]). As such, it envisions a more-than-human approach to public health (Kehr 2020). The shift to a planetary health thinking was driven by the growing awareness that not only are all human communities linked together by flows of commodities, ideas, people, and health-related influences from vectors to medicines, but that the health of human communities is multiply linked to the environment including other species within us (e.g. gut flora) and around us (Singer 2014). Following Marx and others, planetary health posits that capitalism, particularly during the era of industrialisation, engages in ecological damaging production and unsustainable resource consumption putting it in contradiction with nature, resulting in devastating health consequences for both humans and the planetary eco-system. Both capitalist and post-revolutionary states created public health care systems to ensure a relatively healthy work force for the creation of surplus value and economic accumulation and growth, but these varied considerably in their ability to achieve this objective given the socially stratified nature of the capitalist world system.

This article focuses on both emerging and re-emerging infectious diseases, particularly the COVID-19 pandemic, and the growing impact of anthropogenic climate change on health. We argue that given the multiplicity of social structural, health, and environmental contradictions resulting from global capitalism, humanity is now at a juncture where, to ensure planetary health, it needs to transition to an alternative world system based upon social parity and justice, deep democracy, environmental sustainability, and a safe climate, a sweeping mitigation strategy termed eco-socialism. In making this argument, we address questions of social justice and the issue of power and hegemony by asserting that climate mitigation is the needed adaptation for all of humanity (and not just privileged sectors of it) and beyond. Given the unprecedented rate of change that is occurring, we cannot “adapt” (in the conventional sense of the term) our way out of the climate crisis. Rather, we need a new and more fundamental understanding of adaptation that unites social justice and mitigation.

Capitalism in a Metabolic Rift with Nature

The political economy of specific sociocultural systems and the world system generally has profoundly shaped the actual physical reality of nature. Humans are part of nature and are both shaped by and shape it, sometimes for the better and all too often since the advent of capitalism for the worse. Marx termed this a “metabolic rift” with nature (Foster 2000). This concept references “the material estrangement of human beings within capitalist society from the natural conditions which formed the basis for their existence” (Foster 2000, [163]). Foster and Clark (2020) elaborate upon Marx’s concept of metabolic rift and discuss in detail how capitalism plunders nature via commodity production and how this has led to the current anthropogenic threat to the Earth System as we know it. Various environmental economists have come to treat ecological devastation as externalities that can be factored into a cost-benefit market analysis and assert that ultimately economic growth can be decoupled from pollution and greenhouse gas emissions. Foster and Clark (2020, [448]) counter by asserting: “Attempts to ‘green’ capitalism, to make it ‘ecological’ are doomed by the very nature as a system of endless growth.”

The advent of industrial capitalism relied heavily on fossil fuels, initially coal and later oil and natural gas, in order to manufacture machines and a wide array of consumer items, both basic and luxury, to propel initially ships and trains and later motor vehicles and airplanes, but also to power and expand mechanised agriculture. The advent of the Industrial Revolution in England during the late eighteenth century resulted in increased water and air pollution. Due to enclosure laws, peasants were pushed off the land and forced to migrate to emerging factory towns seeking employment in horribly unsanitary and overcrowded slums. In The Condition of the Working Class in England, Engels (1969, orig. 1845) described the devastating impact of industrialisation on the natural environment (and on human health). Furthermore, “Marx gave numerous examples of capitalist pollution: chemical by-products from industrial production; iron filings from machine tool industry; flax, silk, wood, and cotton wastes in the clothing industry; rags and discarded clothing from consumers; and the contamination of London’s River Thames with human waste” (Merchant 1992, [140]).

Capitalist development projects in the Global South, in the form of dam construction, land reclamation, road construction, plantation agriculture, and resettlement of populations, have contributed to the spread of infectious diseases such as malaria and schistosomiasis. As opposed to relatively minor environmental modifications wrought by indigenous societies, the sweeping environmental changes introduced by the capitalist world system, with its emphasis on ever-expanding production and consumption, introduced completely new environmental contaminants, including pollutants, toxic chemicals, pesticides, and plastics, that interfered with natural biochemical processes.

Capitalism has historically assumed that natural resources – not only minerals but also air, water, fertile soil, and trees – exist in unlimited abundance. Moreover, industrial capitalism has expanded into a world system of unequal economic exchange between developed and developing countries, with significant implications for global ecological destruction and human health. Capitalism has been reliant on what Moore (2015, [155]) terms the “Four Cheaps,” cheap raw materials, cheap coal, cheap iron, and cheap steel, all of which exist in limited supply. Multinational corporations and state and joint-venture companies in post-revolutionary societies, particularly China, have created a global factory (including the agrarian factory) and a new global ecosystem that includes industrial and motor vehicle pollution, toxic and radioactive wastes, deforestation, species and biodiversity loss, and climate change contributing to what various scholars have come to term ecocide (Whyte 2020).

The fossil fuel-based technologies driving industrialisation brought about sweeping environment-reshaping changes, including the growth and pollution of the air, water and land of heavily populated cities. These changes had a profound impact on human health. During the twentieth century and continuing into the twenty-first century, the world has witnessed the emergence of teeming metropolitan areas such as Mexico City, São Paulo, Mumbai, Beijing, Shanghai, Jakarta, and Los Angeles that environmental scientists call unhealthy “heat islands”, because of the elevated temperatures that their technologies, concrete roads, buildings, loss of green spaces, and populations, along with global warming, produce. A global energy-intensive food production system, the ever-increasing adoption of motor vehicles, air-conditioning systems, oversized dwelling units and a myriad of consumer items for the affluent, and the increasing use of air travel for business and pleasure, and other developments act to strain a fragile eco-system and ultimately threaten human health (Baer 2019, 2020). Environmental degradation, as a result, has become a primary public health issue internationally in the contemporary world.

Many of these sources of risk are all found, for example, in Shanghai, a megacity of 27 million residents in eastern China that has experienced government-supported rapid growth of industrial production, construction, population size, and traffic volume. Defined by its continuous development of high-rise, high-density residential and office buildings and industrial districts, Shanghai has faced serious environmental health threats from various sources over the last few decades. One such threat is from the release of polycyclic aromatic hydrocarbons (PAHs), a class of chemicals that occur naturally in many fuel sources. Analysis of 26 PAHs by Wang et al. (2013) in soil samples from Shanghai found high levels of contamination. Dibenzopyrenes, a group of PAHs produced during the combustion of wood, coal, gasoline, and diesel exhaust, as well as tires, were of special concern as they are known to have a high carcinogenic potency (Bergvall and Westerholm 2009; Sadiktsis et al. 2012). These researchers conclude that their results demonstrate “Exposure to these soils through direct contact probably poses a significant risk to human health from carcinogenic effects of PAHs” (Wang et al. 2013, [88]). They also warn that PAHs may pose a potential threat to drinking water quality because of leaching of carcinogenic PAH mixtures from soil in the study area. Tracking by the Helsinki-based Centre for Research on Energy and Clean Air (CRECA) and collaborators adds that air pollution is also a significant threat to health in Shanghai. CRECA reported that Shanghai saw an estimated 27,000 deaths in the first six months of 2020 (Reuters 2020). Further, research by Zhang et al. (2018) on air pollution in Shanghai suggests that even short-term exposure to outdoor air in the city may induce the occurrences or exacerbation of pediatric respiratory diseases, upper respiratory infection, and chronic obstructive pulmonary disease. Although recent mitigation efforts (i.e. cultural adaptation) have reduced risk from heavy metals in Shanghai, research by Jaffar et al. (2017) found high levels of pollution from anthropogenic-generated zinc, lead, and cadmium, all known toxicological substances. Moreover, research by Longxun et al. (2003) indicates that Shanghai suffers heat island effects because of high energy consumption tied to rapid economic development.

Overall, the World Health Organization (WHO) (Prüss-Üstün and Corvalán 2006) estimates that thirteen million deaths annually are attributable to preventable environmental causes. WHO estimates that 24% of the global disease burden (healthy life years lost) and 23% of all deaths (premature mortality) are attributable to environmental factors.

While the emergence of global capitalism ultimately ensured plentiful, but unevenly distributed, food resources (including nutritionally dubious ones), modern sanitation, and biomedical healthcare for some, these material benefits have often been obtained at the expense of the masses of people in developing countries and the working class in the developed world.

Emerging and Re-Emerging Infectious Diseases and the COVID-19 Pandemic

Although public health measures and secondarily biomedicine have done much, although by no means enough, to counter the threat of infectious diseases, there has been growing concern in recent years about what have been termed emerging diseases, which include (1) newly described conditions that have been discovered or recognised only within the past few decades (e.g. HIV and SARS, or severe acute respiratory syndrome); (2) expansion of a familiar disease into a new region or habitat (what have been called re-emerging diseases, such as malaria or Zika); (3) marked increase in the local incidence of a disease, as seen with Ebola; and (4) increased severity or duration of an older disease or its increased resistance to previously effective treatment (e.g. tuberculosis).

Acquired immune deficiency syndrome (AIDS) has emerged as one of the most devastating infectious diseases in human history (Singer et al. 2019). While there has been a decline in the level of AIDS-related deaths in recent years, the World Health Organization estimated that 1.1 million people died of the disease in 2015, indicating that the epidemic is far from over. The actual origins of HIV are not precisely known, but it appears to have evolved from similar viruses, called simian immunodeficiency viruses (SIVs), that infect monkey and ape species. Current thinking is that SIV underwent one or more mutations that allowed it to infect human hosts sometime in the late 19th or early twentieth century. The political ecological context for this transition was the expansion of human settlements into previously forested areas in Africa, associated with population explosion, deforestation, expanded agriculture, and more rapid transportation created by colonialism and neo-colonial economies. Whatever its point of origin, HIV found the human body, especially components of the immune system, a habitable and reproductive environment; human sexual contact and pregnancy initially and other routes of transmission eventually (e.g. injection drug use and blood transfusion) approved to be effective mechanisms for moving between hosts and led to its rapid spread within and across populations, particularly poor people, most notably those situated in sub-Saharan Africa. HIV/AIDS, along with many other infectious diseases do not act alone, but rather constitute manifestations of syndemics, a concept that asserts that two or move diseases adversely interact with each other and a variety of often intersecting social and political economic factors, such as access to food and shelter, discrimination, and hindered access to medical treatment, to significantly increase the disease burden of a population (Singer 2009a).

Since at least the devastating so-called Spanish flu of 1918-1919, various factors emanating from capitalist globalisation characterised by interlinked commodity chains largely controlled by multinational corporations and more recently Chinese state corporations have contributed to the spread of infectious diseases. One of these is increasing global interconnectivity driven by international travel and commerce. Singer reports:

Research on shipping shows that the large metal shipping containers now used to move products around the world play a role in spreading other disease vectors and the diseases they transmit. This is one explanation for the diffusion of the West Nile virus to the United States around 1999. Cruise ships create another opportunity for the global movement of infectious agents. In 2010, for example, Cruise Line Association member companies recorded that 14.8 million people travelled by cruise ships with an average travel time of seven days. Visiting various ports of call, cruises increase social connectivity worldwide, whereas cruise ships, as contained space, provide ideal conditions for the rapid spread of infectious agents (Singer 2015, 49–50).

Wuhan, China – the place COVID-19 first appeared – is both a domestic and international hub with (at least prior to COVID-19) over 100 flights to more than 70 countries. Flights from Wuhan quickly carried infected passengers to Bangkok, Hong Kong, Seoul, Singapore, Tokyo, Taipei, Sydney, Melbourne, and London (Horton 2020, [8]). Wild foods, such as those sold in the open-air markets of Wuhan and other cities, have become an increasingly formalised sector in the capitalist world system. As Wallace et al. (2020) observe, COVID-19 likely emerged at a regional terminus in the supply line of wild foods and spread vis-à-vis people travelling on planes, trains, and ships, to other parts of China and across the globe, initially to large cities and later to smaller cities. The various waves of the COVID-19 pandemic thus far have had broad economic and social consequences, including impacting world stock markets, grounding much international aviation, and silencing global cities. Ironically, COVID-19 initially made its way around the globe with the travel of relatively affluent people. It arrived in India through international travellers, hitting the upper classes before percolating to the poor. A similar pattern occurred across the world in Mexico (Singer 2020).

Other factors contributing to the spread of the COVID-19 pandemic (more precisely, a syndemic of COVID-19 and especially non-communicable diseases like diabetes [Singer and Rylko-Bauer 2021]) are social inequality and urbanisation in which one finds large concentrations of poor people, particularly in Global South countries in Asia, Africa, and South America, living in cramped quarters. Social inequality as a by-product of global capitalism results in a lack of adequate nutrition, shelter, clean air and water, access to vital resources, and health care for hundreds of millions in particularly developing societies but also developed societies like the United States, the most stratified advanced capitalist country. Moreover, as Wu et al. (2020) observe, people in the US who live in places with poor air quality and higher historical particulate matter exposures due to pollution are more likely to die from COVID-19 (even when accounting for other factors like pre-existing medical conditions, socioeconomic status, and access to healthcare) than people in less polluted locales.

Malm (2020) portrays a grimmer scenario, observing that there is a complex interaction of global capitalism, climate change, and COVID-19 or other coronavirus diseases. He observes that of the ten countries, namely the US, Italy, China, Spain, Germany, France, Iran, UK, Switzerland, and Netherlands, with the most deaths from COVID-19 as of late March 2020, only Iran and Switzerland were not in the top listing of countries responsible for the most cumulative CO₂ emissions since 1751. SARS appeared in the wake of a drought in Guangdong, MERS first appeared in rain-free Jedda, and SARS-COV-2 erupted amid the worst drought in the Wuhan area in 40 years. Prior to the drought, rising temperatures, sunlight, and atmospheric carbon dioxide caused by greenhouse emissions contributed to an expansion of bat-friendly forest habitat in China's southern province of Yunnan and contiguous regions, making the area a hotspot for bat-borne coronaviruses. Over the past century, at least 40 bat species that harbour 100 more types of bat-borne coronavirus have moved into changing Yunnan ecosystems (Beyer, Manica, and Mora 2021). This combination of infectious disease epidemics and climate change suggests humanity has entered an era of chronic interacting eco-crisis emergency.

Capitalist-driven deforestation and food production, including of wild animals, have resulted in zoonotic spills-over from animals to humans, in many cases starting with bats and intervening wild animals, such as possibly pangolins sold in open-air markets, particularly the one in Wuhan. Akram-Lodhi (2020) report that about 60 percent of new human pathogens cross from animals to humans, meaning in essence that the “world food system has laid the structural foundations to facilitate the expanded spread of zoonotics in the twenty-first century.” Foster and Suwandi argue:

SARS-CoV-2 [the pathogen of COVID-19], like other dangerous pathogens that have emerged or emerged in recent years, is closely related to a complex set of factors including: (1) the development of global agribusiness with its expanding genetic monocultures that increase susceptibility to the contraction of zoonotic diseases from wild to domestic animals to humans; (2) destruction of wild habitats and disruptions of the activities of wild species; and (3) human beings living in closer proximity. There is little doubt that global commodity chains and the kinds of connectivity they have produced have become vectors of the rapid transmission of disease, throwing this whole globally exploitative pattern of development into question (Foster and Suwandi 2020, [11]).

While most health experts came to accept that COVID-19 had emerged in a Wuhan wet market vis-à-vis animal to human transmission, a widespread theory worldwide and particularly in the United States during the Trump presidency was that the virus has developed in a Wuhan research laboratory. While it appears now that this was unlikely, the theory may have been a reflection between rising tensions between the United States as a declining hegemon and China as a rising hegemon.

EU countries source over half of their land-based consumption from other regions of the world, over 80 percent in the case of Germany. At the high end of capitalist-developed countries, one finds Japan which sources 92 percent of its land-based consumption from other regions, and at the low end one finds the US which sources only 33 percent of its land-based consumption from other regions, largely because of its enormous land mass. Initially, the major epicentres of COVID-19 were generally rich cities, such as New York, London, and Hong Kong, but in due time megacities in the Global South, including in India, Brazil, Peru, and Mexico became epicentres of the pandemic, a scenario that is still playing itself out before our eyes.

Whereas during the nineteenth century and first half of the twentieth century, steam-powered trains and ships served to diffuse infectious diseases around the world, airplanes are now the principal transport mode diffusing infectious diseases around the world (although cargo ships remain important). Quarantine and disease control aimed at preventing the spread of infectious diseases on airplanes became enshrined in the 1944 Chicago Convention on International Aviation. The creation of the World Health Organization in 1946 resulted in additional “steps toward the internationalisation of public health measures for aviation” (Budd, Bell, and Brown 2009, [432]). Nevertheless, the internal environment of the airplane is an unhealthy one, with little oxygen “filled with the germs of other passengers,” containing “fungus spores and chemical pesticides at toxic levels,” and “bathed in low-level electromagnetic radiation from flight equipment and x-rays encountered at high altitudes” (Gottdiener 2001, [129]). The outbreak of Severe Acute Respiratory Syndrome (SARS) in late November 2002 to June 2003, which reportedly infected more than 8,000 and killed nearly 800 as it spread from China to at least 20 other countries, illustrates how air transportation can serve as a rapid disseminator of disease (Dierikx 2008, [140-141]). In the case of COVID-19, airplanes along with cruise ships, cargo ships, and aircraft carriers have played a pivotal role in disseminating the virus, with some infected passengers completing their journeys home on airplanes (Mackenzie 2020, [204]). As Malm (2020, [74]) observes, “By late January 2020, the virus had become an unstoppable sponger on the global aviation network.” In late 2021, the governments of developed capitalist countries in Europe, North America, and Australia, feeling reassured by relatively high rates of COVID-19 vaccinations, lifted many of the restrictions on airplane flights. However due to the rapid spread of the highly infectious Omicron variant of COVID-19 from southern Africa vis-à-vis passengers and flight crews, resulting in chaos as airlines were forced to cancel flights during to the busy Christmas holiday rush due to many infected flight crew workers who were forced into quarantine.

Osterholm and Olshaker (2020) predict the possibility of a pandemic much worse than COVID-19, which they term “The Big One,” although they admit that it is difficult to say when it might occur. For the moment, COVID-19 has deflected attention away from climate change given that it seems a more immediate problem. Ironically, the pandemic and consequent shutdowns have resulted in the reduction of greenhouse gas emissions from various sources, including production and consumption and air and motor vehicle travel. It has forced many people to adopt, to a degree. what Australian eco-anarchist Trainer (2019) terms a “Simpler Way,” although multinational corporations and states around the world are doing their utmost to ramp up the capitalist treadmill of production and consumption.

Capitalism, Climate Change, and Health

Global warming and associated climatic events are a direct effect of an increase of greenhouse gas emissions since the Industrial Revolution, which kicked off reliance on fossil fuels. Reportedly 556 billion metric tons of CO₂ emissions have been added to the atmosphere since 1750 as a result of fossil fuel consumption and land cover change due to increased agricultural production and deforestation. Atmospheric CO₂ alone has increased from 280 ppm at the time of the Industrial Revolution to 420 ppm in 2021. In China, labour costs are much cheaper than in developed countries. An increasing percentage of China’s emissions are export emissions generated in the process of largely shipping manufactured goods to developed countries in North America and Europe, as well as Australia, which generally do not count “import emissions” into their totals of emissions for which they are responsible. China, for example, is one of the largest import suppliers of food to the US, especially processed fruit and vegetables.

Although the global burden of disease due to climate change remains relatively small compared to the impacts on health resulting from poverty, poor sanitation, tobacco consumption, and conflict, climate change over the course of the present century – particularly if greenhouse emissions are not drastically reduced soon – will result in increasing adverse impacts on health, particularly among the poor and people living in regions relatively close to the equator. Climate change is already having serious impacts on human, animal, insect, and plant life around the world. South Pacific Islanders face a threat to their traditional horticultural lifestyle because of rising sea levels that inundate their fields and water supplies and threaten to submerge their islands. The indigenous peoples of the Arctic region are experiencing multiple threats due to climate change. Sea ice, which historically protected Arctic shorelines from erosion, is melting and putting over 30 indigenous communities at risk from extreme storms. Andean peoples face the possibility of the eradication of their way of life as glaciers from which they have drawn water for themselves, their fields, and their animals retreat (Singer 2018). These are but two examples of the increasing threat from climate change to populations that are least responsible for greenhouse gas release.

Climate change also is contributing to what Singer (2015, [125]) terms environmentally mediated infectious disease. It appears to be the primary impetus behind the spread of infectious diseases to environments north and south of the equator. Warmer temperatures have contributed to the spread of mosquito-borne disease, such as malaria, in southern Africa, the highlands of Kenya and Tanzania where it was previously non-existent, as well as to higher elevations in the Andes of Colombia. Disease-carrying mosquitoes that only lived in altitudes no higher than 3,200 feet in the past are now appearing at the 7,200-foot level (Berger 2000). Climate change has been implicated in the resurgence of various epidemics, including cholera in Latin America in 1991, pneumonic plague in India in 1994, and the outbreak of a hantavirus epidemic in the US Southwest in 1994. Even in temperate zones, climate change may contribute to greater frequency of tick-borne diseases including Lyme disease (McMichael 2001; Singer and Bulled 2016). Michael Klare (2019) and Singer (2017) discuss the dangers of deadly diseases of the spread of vector-borne diseases, such as Zika virus and dengue fever, into new regions. Notes Klare:

Adding to the danger of future pandemics is the looming breakdown of public health systems in many poor and conflict-ravaged countries. Epidemics that can be effectively controlled by medical authorities in well-functioning societies are likely to gain momentum when health systems collapse – an outcome that will prove increasingly likely as more and more states are impacted by climate shock waves (Klare 2019, [107]).

He adds that the Ebola epidemic of 2014–16 represents a preview of what can be expected in the future as global warming advances, certain infectious diseases extend their range, and vulnerable states prove unable to cope with the multiple challenges of extreme weather, resource scarcity, and inadequate public institutions (Klare 2019).

Furthermore, climate change may endanger people’s health and even their lives through heat exhaustion. The estimated mortality of some 70,000 people in the case of Western Europe in 2003 and 55,000 people in Russia in 2010 was associated not only with high temperatures but also with the fact that night-time low temperatures have been rising nearly twice as fast as day-time temperatures (McMichael, Woodward, and Muir 2017). The lingering night-time warmth deprived people of normal relief from blistering day-time temperatures and the opportunity to recuperate from heat stress. Air pollution linked to longer, warmer summers particularly affects those suffering from respiratory problems, such as asthma. The heat waves in Western Europe in 2003 and Russia in 2010 contributed to 30 percent declines in grain harvests, accompanied by increases in food prices, food shortages, and nutritional deficiencies among the poor in grain-importing countries (McMichael, Woodward, and Muir 2017). Elderly people with higher blood pressure and/or heart disease along with possible obesity are particularly likely to die or require medical attention during heat waves.

Given the health consequences of climate change, we can speak of diseases of global warming or climate change (Baer and Singer 2009). These would not necessarily be new diseases, although they might be, but would include any “tropical” disease (e.g. malaria and dengue fever) that spreads to new places and peoples because of global warming as well as diseases linked to poor nutrition due to desertification of pastoral areas or flooding of agricultural areas. Singer (2009b) developed the term ecosyndemic to label the role of anthropogenic changes in the environment and climate that increase the frequency of adverse disease interactions and, as a result, increase the health burden of affection populations. Ecosyndemics are likely to concentrate among the poor and other marginal communities, who are least able to obtain adequate nutrition, sanitation, shelter, low-stress life experiences, and preventive and curative health care. Diseases that have increased in range because of global warming include malaria, dengue, Rift Valley fever, West Nile disease, Chikungunya fever, yellow fever, hantavirus, Seoul virus, and Zika. Furthermore, water-borne diseases such as cholera are spreading because of ever-warmer oceans (Singer, Shoreman-Ouimet, and Graham 2022).

Although all countries and regions of the world are suffering the ill effects of climate change as well as other forms of pollution and environmental degradation, as well as eco-crisis interaction (Singer 2021), poor countries and poor people in all countries, namely those who are generally least responsible for pushing the Earth system toward even more drastic environmental and climatic changes, are the victims disproportionally dealing with the consequences. While the injustice of the existing capitalist world system is recognised by mainstream global bodies such as the United Nations in the form of the Sustainable Development Goals and the World Bank in its call to eradicate extreme poverty, such bodies generally do not call for a drastic redistribution of the wealth and resources of humanity nor do they recognise the limits to economic growth, stances that are imperative for addressing the health ravages of the ecological and climate crises, particularly for the poor.

Eco-Socialism as a Pathway to Planetary Health

This discussion points to the need for an economic transcendence (a term derived from the phonetized Greek notion of house or habit, and nómos, “law”), of capitalist society, that is, the creation of a novel adaptation that provides a pathway to an ecologically sustainable and socially equitable human way of life on Earth (Singer 2010). Needed for this initiative is a truly planetary health perspective. The challenge before us is determining how we can collectively address monumental political-economic, social structural, demographic, health, and ecological problems, and how to partake in a larger effort to create a just, democratic, environmentally, and healthy global community, all of which will require a safe climate. Such a new world will require not only creating healthy living conditions but ensuring that everyone has access to healthcare that draws not only from biomedicine but also from a wide array of indigenous and complementary medical traditions and practices. The creation of a healthy planet for both humanity, non-human animal and plant life, and planetary ecosystems will, over the long run, require the transcendence of the present global economy and a movement towards a more equitable, just, and ecologically sustainable global order. Emergence of such a mitigation strategy is dependent on a vision for an alternative to the present global capitalist world order. Moreover, as reflected in the growing anti-ecocide movement, which seeks to criminalise corporate mass environmental destruction – a view endorsed by Pope Francis (Esteves 2019) –, there are legal and moral components in a planetary health adaptation.

In sum, humanity needs to undergo a multidimensional adaptive socio-ecological revolution, an idea which has slowly been gathering attention as it becomes clear that the present world system is highly deficient on numerous fronts, including maintaining healthy populations and societies (Foster 2009; Baer 2018). Achieving a healthier world population will require an alternative world system based upon social justice, democratic processes, environmental sustainability, and a safe climate. As Somerville (2021, [44-45]) observes, “Eco-socialism holds that capitalism is no respecter of natural limits, and there must be overthrown or transformed into socialism.”

Numerous proposals for achieving an alternative world system have been offered and go by labels such as radical democracy, Earth democracy, economic democracy, global democracy, eco-socialism, or Green socialism (Ghotge 2018). Many have argued that socialism has been tried in places like the Soviet Union and China, and even Cuba for that matter, and has proven wanting. While of these societies Cuba comes closest to embodying socialist ideals and practices, socialism, let alone global democracy or eco-socialism, remains a vision rather than an existing social system in any country. Cuba, along with the state of Kerala in India, and Venezuela, at least until recently, have managed to provide healthcare services far superior to most developing countries and in the case of Cuba, rivalling those of the United States.

The history of the Soviet Union and Stalinism tells us that socialism cannot be created in “one country.” The struggle for a safe climate needs to be part and parcel of a larger struggle for social justice and environmental sustainability, both internationally and within specific nation-states. As Magdoff and Foster (2010, [25]) aptly argue, “Everywhere radical, essentially anti-capitalist strategies, are emerging, based on other ethics and forms of organisation, rather than the profit motive.” As the House Organ of Capitalism Nature Socialism observes,

Nature in itself or any part thereof is beyond valuation; it is the valuation of what we live in relation to and live through or experience. With this mind, the specifically capitalist value system and ecological destruction it brings can be effectively identified, analysed, and eventually overcome with other value systems (not with different ways of veining nature itself), including those that still exist interstitially within or (now rarely) outside capitalist formations, value systems not bound to privileging profits over people and other organisms (House Organ 2019, [154]).

While Cuba remains a poor developing country with its own contradictions, it has achieved statistics in terms of infant mortality and life expectancy that rival those of developed societies, particularly the United States, and it has the lowest HIV prevalence in the Americas and one of the lowest in the world. Cuba's commitment to health has led to a comparatively successful COVID-19 response, although it has been weakened by decaying infrastructure and financial and supplier challenges which grew worse with the increased sanctions imposed by Donald Trump while the US president. SARS-CoV-2 infection rates were contained during most of 2020, as they were soaring in the U.S. and Europe. However, like Europe, Cuba has experienced a surge of infections in 2021 following the admission of more tourists. As of March 8, 2021, the country endured almost 56,000 cases of COVID-19 and 348 deaths, with over 23,000 new cases occurring in February alone (Burki 2021). Still, Cuba is in better shape than most countries in the region. Government and public health officials recognised that a vaccine was urgently needed and initiated efforts at the Finlay Vaccine Institute and at the Centre for Genetic Engineering and Biotechnology in Havana. In June 2021, Cuba reported that its three-shot Abdala vaccine had proved to be 92.28% and subsequently initiated mass vaccination (Reuters 2021). Cuba is the first Latin American country to develop its own vaccine. The country is attempting to fully vaccine its own population and share its vaccine with other developing countries. In September 2021, Cuba began commercial export of the Abdala vaccine to Vietnam and Venezuela. Notably, more than 1,000 Cuban health-care workers are helping other countries respond to the pandemic.

Proposals such as global democracy and eco-socialism constitute longer-term steps in the creation of a better world for both humanity and health of its inhabitants and the planet. Developing an alternative to global capitalism, namely eco-socialism, constitutes the “ultimate climate strategy, even if it will not be achieved anytime soon, if need ever” (Baer 2019, [3]). In essence, for humanity, to paraphrase Rosa Luxemburg, we have a choice: “eco-socialism or eco-barbarism.” The application of these radical transitional reforms will require adaptation to the varied political, economic, and sociocultural traditions and ecological conditions in both developed and developing societies. In contrast to capitalism, which focuses on profit-making or the creation of surplus value, as Kallis (2019, [15]) argues, socialist politics are “about specifics, about concrete use values: employment, a decent wage, dignified conditions of living, a health environment, education, public health or clean water for all.”

Eco-socialism constitutes what Olin Erik Wright (2010) terms a real utopia, a utopian vision that is practically achievable through much theorising and social experimentation. It is parcel and parcel of the struggle for a healthy population around the world which in turn is intricately interwoven with many other struggles, including those for social justice, democracy, environmental sustainability, and a safe climate. More recently, Aisnik (2022) views envision eco-socialism as a real utopia, one that draws in part upon early utopian socialist visions, in an era of socio-ecological crisis, which includes the recent COVID-19 pandemic.

In terms of health, it is essential that everyone on the planet has access to adequate and nutritious food, clean water, basic housing, comprehensive health care, education, satisfying and un-alienated work, and a sense of community. Achieving these goals will require a drastic redistribution of resources around the world, which the capitalist class and its political allies will resist with incredible and violent force if it so deems necessary. Further, this class will use its enormous wealth and power to hire poor and working people as thugs or as members of militias, police departments, and the military to enforce its will. Nevertheless, progressive people need to strategize how to unify their efforts in the struggle for a better and healthier world.

While poorer regions of the world need economic development, that is, access to basic resources and health care (however on an equitable basis in contrast to the growing social inequality characteristic of countries such as China and India), much of the developed world and parts of the developing world are, in a sense overdeveloped, thus needing to undergo degrowth (Andreucci and Engel-Di Mauro 2019; Kallis 2019). The vast wealth of economic and political elites, and their lavish lifestyles, in particular, constitute an essential threat to the planet. As Foster (2000, [82]) observes, “[a]ny discussion of the global ecological must therefore concentrate on the excesses of the advanced capitalist states, and their impact on the world economy.” Loewy succinctly argues:

The countries of the South, where . . . [basic material] needs are very far from being satisfied, will need a much higher development of “development” – building railroads, hospitals, sewage systems, and other infrastructures – than the advanced industrial ones. But there is no reason why this cannot be accomplished with a productive system that is environmentally-friendly and based on renewable energies (Loewy 2006, [303]).

Perhaps more than any other issue, the ecological crisis, which includes catastrophic climate change allows critical scholars to contemplate the contradictions of the capitalist world system, including its implications for health, and to ponder the creation of an alternative world system, one committed to social justice and equality, democracy, environmental sustainable, and a cooler planet; one world, in other words, in which humans live in harmony with each other and in balance with their home, a world committed to planetary health for our species and the broader eco-system. We cannot stop the environment from changing – as it has always been in motion – but we can radically slow down our role in adverse change. Unlike capitalism, eco-socialism offers a potential pathway to planetary health.

Disclosure Statement

No potential conflict of interest was reported by the author(s).