Integrating Planetary Health in Health Guidelines (GRADE Guidance 46)

Human health and natural systems are intrinsically linked-stable natural systems enable healthy human life. Health systems aim to promote, restore, and maintain health. Health systems may promote human health while having detrimental effects on natural systems, contributing to the transgression of planetary boundaries, such as biosphere integrity, climate change, and the introduction of new entities like microplastics. To date, the health guideline field lacks methods to assess the impacts of health interventions on planetary boundaries. The GRADE (Grading of Recommendations Assessment, Development and Evaluation) Working Group established the Planetary Health Project Group in 2023 to develop formal GRADE guidance for integrating planetary health into guideline recommendations to address this gap. Guided by the concepts of planetary health and planetary boundaries and following established methods for GRADE guidance development, the project group conducted iterative case study analyses, expert workshops, and a 2-round global Delphi consensus process. Four case studies were selected for application of this guidance before recommendations were finalized. The GRADE Working Group approved the official guidance. The Planetary Health Project Group presents 7 domains of guidance for incorporating planetary health aspects into the guideline development process, including highly desirable items and optional items. Highly desirable items include formally addressing planetary health in public health and health system guidelines and explicitly justifying its exclusion where it is not addressed. Judgments within the evidence-to-decision (EtD) framework should systematically integrate included evidence across the prioritized planetary boundaries and equity. This guidance aims to support guideline developers and policymakers in making evidence-based, trustworthy recommendations to protect individual and planetary health, while maintaining thoroughness and feasibility for guideline developers within the GRADE approach.

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Publication Details

Journal
Annals of Internal Medicine
Published
2026-05-11
DOI
https://doi.org/10.7326/annals-25-04761
Citations
1
Primary Topic
Global Public Health Policies and Epidemiology
Type
article
Field-Weighted Citation Impact
42.41
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article

Integrating Planetary Health in Health Guidelines (GRADE Guidance 46)

Emily Senerth, Philipp Dahm, Sylvie Laot-Cabon, Uwe Siebert et al.
1 citations
Annals of Internal Medicine
Global Public Health Policies and Epidemiology
42.41
article

Integrating Planetary Health in Health Guidelines (GRADE Guidance 46)

Emily Senerth, Philipp Dahm, Sylvie Laot-Cabon, Uwe Siebert, Gunn Elisabeth Vist, Pablo Alonso‐Coello, J Bousquet, Tuuli Thomander, Michela Cinquini, Eva Madrid, Aírton Tetelbom Stein, Elie A. Akl, Franca Barbic, Antonio Bognanni, Francesco Nonino, Grigorios I. Leontiadis, Rebecca L. Morgan, Srinivas Murthy, Alina Herrmann, Elisabetta Poluzzi, Maria-Intí Metzendorf, Pakeezah Saadat, Lukas Schwingshackl, Andrea Darzi, Q Wang, Mehdi Aloosh, Nicole Skoetz, Klaas Miersch, Holger Schünemann, Ignacio Neumann, Oyekola Oloyede, J Bracchiglione, Rafael José Vieira, KM Saif-Ur-Rahman, Joerg Meerpohl, Malgorzata M. Bala, Bernardo Sousa-Pinto, Francesca de’Donato, Josep M. Antó, Kavin Qiu, Miranda Cumpston, Charlotte Michels, Thomas Piggott, Madelin R. Siedler, Karolina A. Scahill, Andy Haines, Stefanie Hofstede, Lorna Benton, Lenny Vasanthan Thinagaran
article en
1 citations

Abstract

Human health and natural systems are intrinsically linked-stable natural systems enable healthy human life. Health systems aim to promote, restore, and maintain health. Health systems may promote human health while having detrimental effects on natural systems, contributing to the transgression of planetary boundaries, such as biosphere integrity, climate change, and the introduction of new entities like microplastics. To date, the health guideline field lacks methods to assess the impacts of health interventions on planetary boundaries. The GRADE (Grading of Recommendations Assessment, Development and Evaluation) Working Group established the Planetary Health Project Group in 2023 to develop formal GRADE guidance for integrating planetary health into guideline recommendations to address this gap. Guided by the concepts of planetary health and planetary boundaries and following established methods for GRADE guidance development, the project group conducted iterative case study analyses, expert workshops, and a 2-round global Delphi consensus process. Four case studies were selected for application of this guidance before recommendations were finalized. The GRADE Working Group approved the official guidance. The Planetary Health Project Group presents 7 domains of guidance for incorporating planetary health aspects into the guideline development process, including highly desirable items and optional items. Highly desirable items include formally addressing planetary health in public health and health system guidelines and explicitly justifying its exclusion where it is not addressed. Judgments within the evidence-to-decision (EtD) framework should systematically integrate included evidence across the prioritized planetary boundaries and equity. This guidance aims to support guideline developers and policymakers in making evidence-based, trustworthy recommendations to protect individual and planetary health, while maintaining thoroughness and feasibility for guideline developers within the GRADE approach.

Annals of Internal Medicine
University of Copenhagen (DK), Jagiellonian University (PL), University of Minnesota (US), Norwegian Institute of Public Health (NO), University of Helsinki (FI), Humanitas University (IT), Universidade Federal de Ciências da Saúde de Porto Alegre (BR), University of British Columbia (CA), University of Freiburg (DE), Christian Medical College, Vellore (IN), Universidade do Porto (PT), Ollscoil na Gaillimhe – University of Galway (IE), Mario Negri Institute for Pharmacological Research (IT), Heidelberg University (DE), Cleveland Foundation (US), University of Minnesota System (US), University Medical Center Freiburg (DE), Instituto de Salud Carlos III (ES), University Hospital Heidelberg (DE), Sefako Makgatho Health Sciences University (ZA), San Sebastián University (CL), London School of Hygiene & Tropical Medicine (GB), Royal Dutch Pharmacists Association (NL), Santé Publique France (FR), Christian Medical College (IN), UMIT - Private Universität für Gesundheitswissenschaften, Medizinische Informatik und Technik (AT), Cleveland Heights University Heights Public Library (US), Institute of Neurological Sciences (IT), Monash Health (AU), Decision Sciences (United States) (US), Agenzia Regionale Parchi (IT), Barcelona Institute for Global Health (ES), Iberoamerican Cochrane Centre (ES), University Hospital Cologne (DE), Azienda Sanitaria Locale Roma 3 (IT), IRCCS Humanitas Research Hospital (IT), Heinrich Heine University Düsseldorf (DE), Potsdam Institute for Climate Impact Research (DE), Cochrane (GB), Hamilton Health Sciences (CA), Charité - Universitätsmedizin Berlin (DE), College of Saint Benedict and Saint John's University (US), University of Hong Kong (HK), University of Bologna (IT), McMaster University (CA), American University of Beirut (LB)
Openalex Percentile: Top 0%
Global Public Health Policies and Epidemiology
42.41
DOISourceOpenAlex
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