key: cord-268947-rh6n0u9n authors: Frumkin, Howard; Myers, Samuel S title: Planetary health and the 2020 US election date: 2020-09-29 journal: Lancet DOI: 10.1016/s0140-6736(20)32038-9 sha: doc_id: 268947 cord_uid: rh6n0u9n nan Elections impact health through changes in both healthcare delivery 1 and upstream social and environmental policies. The upcoming US election presents stark contrasts in environmental policies that will affect health in the USA and globally. Here we examine these contrasts through the lens of planetary health. 2 A hallmark of the current US administration has been its hostility to environmental stewardship and its embrace of an antiregulatory agenda. President Donald Trump has appointed administration officials from the ranks of polluting industries and their lobbying firms; 3 eviscerated some key government agencies; 4 and diluted or overturned environmental regulations (table) . Notably, Trump has called climate change a hoax and has cast doubt on established science. 5 The Democratic presidential candidate, Joe Biden, has stronger pro-environmental positions as evidenced by the actions of the Obama administration in which he served and by his published 2020 election platform on a clean energy revolution and environmental justice. 6 The candidates' environmental policy positions to date are outlined in the table. Climate change policy provides one of the sharpest distinctions between Trump and Biden. Climate change has extensive health implications through pathways that include severe weather events, infectious disease spread, hunger and reduced nutrition, mental health effects, and forced migration and conflict. 7 The Trump administration's denial of climate science, withdrawal from the Paris Accords, and dismantling of climate policy increase the risk of these outcomes in the USA and globally. 8, 9 By contrast, Biden's proposed climate change policies would be expected to yield health benefits; mitigation action delivers health co-benefits 10, 11 and adaptation, such as disaster planning, heatwave preparedness, and planned relocation, can reduce human suffering. 12, 13 The growing field of planetary health makes clear that other areas of environmental policy impact on health. 2 Protection of terrestrial and marine biodiversity may limit infectious disease exposure, promote mental health, facilitate pharmaceuticals discovery, and improve nutrition. 14 Protecting the recreational, cultural, and spiritual value of access to undisturbed public lands has a role in supporting mental and physical health. 15.16 Safeguarding human health from pollution of air, water, and soil was a core reason for establishing the US Environmental Protection Agency (EPA) in 1970, and the Trump administration's weakening of these safeguards puts Americans at increased risk of cardiorespiratory disease, endocrine and neurobehavioural abnormalities, and some cancers. 17 Some of the health consequences of post-election environmental policies will be felt in the near term, whereas others will be delayed. For example, adaptation actions such as pandemic preparedness are expected to be stronger under a Biden presidency than under a Trump presidency, as shown by the current administration's COVID-19 response. Action to reduce emissions from power plants and motor vehicles can yield reduced air pollution, and health benefits, within months to years. But some health benefits of policies that conserve land, water, and biodiversity will only manifest over many years. The environmental policies that are pursued after this election will be felt in the USA and globally. Actions to protect rivers and streams, for example, will mainly benefit those in the affected watersheds, and continued soil loss will compromise local agriculture. But persistent toxic chemical emissions do not remain in place; 17 they circulate globally in processes that are accelerating with climate change. 18 The health implications of promoting versus obstructing climate action will be felt worldwide and across future generations. Although a Biden presidency would be expected to advance planetary health more than a second Trump term, there are likely to be limits to these benefits. First, Biden's policies do not go far enough for many environmentalists. For example, unlike some of his opponents in the Democratic Party presidential primary race, Biden has stopped short of promising to ban fracking, despite its direct and indirect adverse health effects. 19 Critics have pointed to Biden's continued reliance on advisers associated with the Obama administration's "all of the above" energy strategy, some with links to the fossil fuel industry. 20 Second, although the US President has considerable power through agency appointments and executive orders, legislative solutions and budgeting rest with the US Congress. A Republican majority in either or both houses of Congress could stymie progress. Third, many US environmental policies face legal challenges and Trump has established a highly conservative judiciary. This is a fraught historical moment. In the months leading up to the 2020 election, fires have consumed more than 7 million acres of western forests in the USA. Hurricanes in the Atlantic and the Gulf of Mexico led to the deaths of over 100 Americans in states from North Carolina to Texas, and caused more than US$20 billion in damages. 21 Efforts to move people to safety from these disasters have been hampered by the COVID-19 pandemic. These emergencies arise in the context of the larger global climate emergency. According to the Intergovernmental Panel on Climate Change, the window for reductions in greenhouse gas emissions to avoid catastrophic climate change is rapidly closing. 22 Similarly, the Intergovernmental Science-Policy Platform on Biodiversity and Ecosystem Services warns that there is only a short time to act on threats to biodiversity. 23 Continued reliance on fossil fuels, destruction of ecosystems, dissemination of persistent toxic chemicals, and other environmental depredations-many of them permitted, if not promoted, during the Trump presidency-are inconsistent with a healthy future for humanity. The alternative is a transition to ways of living that protect both natural systems and the health of current and future generations. This path requires new approaches to generating energy, producing and consuming food, chemicals, and other manufactured goods, travelling, and designing and building cities. The vast public investments some governments are making during the COVID-19 pandemic could spur this transition, 24 and US leadership could be catalytic. The outcome of the US election will have far-reaching consequences for planetary health. We declare no competing interests. Access to health care and the 2020 US election Planetary health: protecting nature to protect ourselves President Trump nominates acting EPA Chief Andrew Wheeler, a former coal lobbyist, to lead agency Trump broke the agencies that were supposed to stop the COVID-19 epidemic Beijing says it is anything but. 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