The Future of Health on a Damaged Planet

In the late 1960s, a sociologist named Aaron Antonovsky began working with female Holocaust survivors in a study of menopausal women with the goal of understanding the psychological and physical effects of enduring “a horror” — the term he used to describe past trauma, finding “stressor” too banal a term — later in their lives. Most of the women who had survived the Holocaust, he found, were less healthy than the women who did not experience it. But a third of the survivors appeared no different at all, living as if they had undergone no agony all those years ago.

What explained those women’s ability to thrive became a driving question in Antonovsky’s research. “What,” he asked later, “was the miracle?” Answering it led him to develop the concept of salutogenesis — the origins (genesis) of health (saluto). At the time, and still today, the foundation of health as a profession and idea is pathogenesis — the origins of suffering or disease. Antonovsky was under no illusions that his salutogenesis model would displace society’s focus on discovering the causes and treatments of disease (“pathogenesis is too deeply entrenched in our thinking,” he later wrote), but he became convinced that sickness was not the reason for ill-health, for a person’s “breakdown.” Rather than simply treating disease, he believed, focusing on “adaptability” was a wiser direction for human health at a societal level. “Salutogenesis,” he wrote, “leads us to focus on the overall problem of active adaptation to an inevitably stressor-rich environment.”

Half a century later, in most of the world, humanity’s prevailing conception of health remains sadly constrained to a vision of the individual body. We invest immense intellectual and financial capital in charting the intricate pathways of pathogens, mapping the probabilistic landscapes of genetic predispositions and analyzing the consequences of lifestyle choices. The domain of pathogenesis has yielded undeniable triumphs but still operates with an almost willful blindness to the larger drama unfolding around us.

As planetary systems buckle under the cumulative weight of industrial modernity, the pathogenic focus reveals itself as insufficient, a form of myopia in an age demanding panoramic vision. The cascading crises of the Anthropocene aren’t merely inconvenient background noise — they are becoming the foundational context that dictates the terms of human existence and demands a radical rethinking of well-being itself.

Given the predicament of the Anthropocene — of global pandemics, industrial pollution, cascading biodiversity losses and the climate crisis — Antonovsky’s concept of salutogenesis has an augmented relevance. What if the most salient factors shaping health today lie not within the atomized individual or even their immediate social milieu, but in the fractured, volatile relationship between our species and the Earth system itself?

Traditional salutogenesis isn’t enough to answer this inquiry. We must enlarge it to match the scale of our impact by embracing planetary salutogenesis.

Adding the idea of the planetary to salutogenesis isn’t just an effort to insert an “environmental” layer into existing health models. It requires a radical revision of how we understand what constitutes collective human health. 

Today’s dominant medical paradigm treats individual personal health as the primary object of concern and relegates the environment to the status of an external variable to be managed or mitigated. Planetary salutogenesis proposes a reversal: that planetary health is the fundamental condition, the enabling context, out of which durable human health, both individual and collective, emerges.

This reversal doesn’t diminish the importance of personal well-being, but rather resituates it. It suggests that the pursuit of individual health, when disconnected from the health of the encompassing biosphere, becomes a Sisyphean task. This perspective understands planetary health not as a singular, uniform state to be achieved through top-down decree, but as a dynamic condition whose specific manifestations — its institutional forms, cultural expressions and ecological integrations — will vary across diverse places and times.

How a community in Africa’s drought-prone Sahel region achieves coherence and well-being will, of course, differ from how a coastal city like Bangkok or Amsterdam facing sea level rise works toward the same goal. Yet all are bound by the overarching reality of planetary systems under stress. The governance structures, economic models, social practices and technological systems through which communities strive for health must adapt to this planetary condition, finding locally resonant forms that acknowledge planetary biophysical realities.

This shift moves beyond universal prescriptions toward context-sensitive evaluation strategies rooted in an understanding of interconnectedness, recognizing that the “health” of a specific human community is inseparable from the health of its watershed, airshed, surrounding ecosystems and, ultimately, the planetary system as a whole.

Health Through Resilience

Antonovsky sought to understand not why people became ill under pressure (pathogenesis), but why some managed to maintain or regain health and subjective well-being despite sometimes horrific experiences and circumstances. He pivoted away from risk factors and disease to identify the resources and capacities that instead fostered resilience. His central theoretical construct was what he called a “sense of coherence” (SOC): the confidence that one’s internal and external environments are, if not stable, then at least predictable, and furthermore that there is a high probability that everything will work out as reasonably as can be expected.

Antonovsky identified three core components of a strong SOC:

1. Comprehensibility: The perception of one’s internal and external environments as structured, predictable and explicable, rather than chaotic, random or baffling. It’s the feeling that the world, at least in broad strokes, makes sense. 
2. Manageability: The understanding that resources are available — under one’s own control or the control of trusted others — that are adequate to meet the demands posed by these environments. It’s the confidence that one can cope.
3. Meaningfulness: The feeling that life makes emotional sense, that at least some of the problems and demands posed by living are worth engagement, commitment and investment; that challenges are embraced rather than seen as unwelcome burdens. It’s the conviction that life has purpose.

A strong SOC, Antonovsky argued, acts as a buffer against stress, enabling individuals to mobilize resources and perceive challenges as manageable rather than insurmountable. Under stable social and environmental conditions, cultivating this coherence is a psychosocial task shaped by upbringing, social support and personal experiences.

But we no longer live in stable times. The Anthropocene is destabilizing the background conditions upon which a robust SOC depends. Our species is inseparably entangled within the dynamic atmospheric and biochemical systems of Earth. This is a non-negotiable biophysical reality underpinning all existence. Planetary thinking compels us to see Earth not as a passive backdrop or a standing reserve of unlimited resources, but as an active, complex and volatile system that has been perturbed by modernity’s industrial metabolism.

This planetary turn undermines the foundations of coherence. How can the world feel comprehensible when established climate patterns dissolve into unfathomable extremes, when intricate ecological webs unravel with terrifying speed, when the slow violence of industrial toxins manifests everywhere from polar ice caps to human placentas? The nonlinear dynamics, feedback loops and potential tipping points within the Earth system defy simple prediction, fostering a pervasive sense of ontological insecurity — a feeling that the basic rules of the world are changing in unpredictable ways. The environment shifts from a reliable constant to a source of radical uncertainty. Unintelligibility prevails.

Simultaneously, manageability seems to evaporate. What personal savings, community initiatives or even national resources feel adequate against the existential threat of runaway climate change, biodiversity collapse or pandemics fueled by ecological disruption? The scale mismatch between planetary challenges and existing governance structures (which are often locked within the Westphalian logic of nation-states) or individual coping strategies becomes clear. A paralyzing sense of being overwhelmed, of lacking the necessary tools and capacities to navigate this new reality, breeds widespread anxiety and resignation. Our traditional reservoirs of resilience feel pathetic when arrayed against forces operating on geological timescales and planetary spatial scales. The sense of agency fades.

And what of meaningfulness? When confronted with credible scenarios of civilizational destabilization or ecological collapse, how can a person maintain the conviction that life’s challenges are worth engaging? Too often, the magnitude of the predicament induces anxiety, despair, solastalgia, or a retreat into cynical denialism or short-sighted hedonism. If the future appears foreclosed, or if individual actions feel like futile gestures against systemic inertia, the motivation to invest effort or find purpose can wither. The grand narrative of perpetual progress, long a source of collective meaning in industrial societies, falters against the stark evidence of planetary overshoot and ecological debt. A feeling of hopelessness abounds.

From Pathogenesis To Planetary Salutogenesis

This erosion of coherence cannot be adequately understood, let alone countered, by remaining wedded to an individualistic or anthropocentric frame. It demands acknowledging a deeper reality: Human health is inseparable from the planetary systems we inhabit and constitute. We are not self-contained biological units interacting with a passive external “environment.” Rather, as biologist Scott Gilbert has described, we are holobionts in a vast, interconnected, living web encompassing microbial, atmospheric, oceanic and terrestrial ecosystems.

Concepts like the “eco-holobiont” capture this reality of the human organism itself as a complex ecosystem, intrinsically linked to and shaped by its surrounding ecological matrix. Our internal environments mirror our external ones. Soil influences the human gut; fresh air and sunshine impact our physiological functioning; biodiversity affects our immune system and mental health.  

What this means is that planetary destabilization isn’t just an external stressor — it is an insult to our biological, psychological and spiritual integrity. Environmental toxins don’t just surround us; they permeate us. Climate change doesn’t just cause floods and fires; it fuels novel disease vectors and disrupts food security. Ecological degradation doesn’t just diminish nature’s beauty; it erodes our sources of physical and psychospiritual nourishment.

An approach to health that is confined to the individual while ignoring this broader context is like carefully tending a wilting flower while ignoring the poisoned soil, acid rain and encroaching desert around it.  

Planetary salutogenesis, then, represents a necessary extension of Antonovsky’s original concept, explicitly acknowledging the planetary scale of our interconnectedness and predicament. It reframes our approach to health and well-being by contrasting it with the assumptions of individual pathogenesis.

From a focus on eliminating disease to supporting well-being: proactively creating the ecological, social, economic and cultural conditions that allow diverse beings (human and nonhuman) to flourish within a thriving total system.

From treatment to prevention: emphasizing the need to confront upstream drivers of ill health — industrial agriculture, fossil fuel dependence, inequitable economic models, anthropocentric worldviews, etc.

From ego-system to ecosystem: recognizing that health is relational and emergent, arising from mutualistic, regenerative relationships between humans and the more-than-human world.

From genome to exposome: highlighting the critical importance of the exposome — the totality of environmental exposures (chemical, biological, social, physical) from conception onwards — in shaping health trajectories. 

From point intervention to continuous engagement: calling for continuous engagement in cultivating health-promoting environments and relationships, which involves ongoing stewardship of ecosystems, adaptive management of resources, lifelong learning and fostering resilient communities.

From fixing to adapting: embracing a mindset of managing complex, dynamic systems and adapting to ongoing change and uncertainty.

From analysis to meaning-making: emphasizing the vital role of finding purpose, belonging and narrative coherence within the context of our planetary situation. 

From sustainability to habitability: pushing toward the crucial goal of ensuring Earth remains a viable, flourishing home for diverse life forms, including humans, over the long term.

From growth to balance: abandoning an economic paradigm obsessed with perpetual growth in favor of ecological economics that emphasize the need for balance and recognize biophysical limits.

From anthropocentric to ecocentric: solidifying the intrinsic value of other species and ecosystems, enabling an understanding that human health is entirely interdependent with the health of the biosphere as a whole.

Health In A Sick Society

Decades before the Anthropocene became a household term, the iconoclastic thinker Ivan Illich, in his seminal work “Medical Nemesis” (1975), offered a critique of contemporary medical practices that resonates with the core tenets of planetary salutogenesis. While not using the term itself, Illich’s work laid bare the iatrogenic nature of modern medicine — its tendency to create new forms of illness and dependency even as it sought cures. He argued forcefully against the medicalization of life, the expropriation of health by professional elites and the illusion that health could be manufactured and consumed like any other commodity.

Underlying Illich’s critique was the proto-salutogenic insight that the pursuit of personal health within a fundamentally “sick” or pathogenic environment is illusory, if not downright counterproductive. He emphasized how modern societal structures — industrial production, car-centric urban design, consumerist culture — generated conditions inimical to well-being and created dependencies on post hoc medical interventions to patch up the damage wrought by the system itself.

For Illich, the primary problem was institutional. “The medical establishment,” he famously declared, “has become a major threat to health.” Illich proposed shifting the focus from professionally managed “healthcare” toward fostering the conditions that would enable people to manage their own frailties and finitude. True health wasn’t the absence of disease but the autonomous capacity of individuals and communities to cope with reality: to suffer, heal and grow within the context of their lives and environments. Trying to achieve peak physical fitness through punishing gym routines while breathing polluted air, eating industrially processed food and living in socially fragmented communities struck Illich as deeply perverse.

Striving for individual and community well-being while ignoring the systemic degradation of the Earth’s life-support systems is a similarly flawed enterprise. It is an attempt to cultivate resilience on unstable ground. Illich’s ghost warns us against seeking technological or medical fixes for problems whose roots lie in our dysfunctional relationship with the planet itself.

Rebuilding Coherence On A Planetary Scale

Planetary salutogenesis’s hopeful proposition is to find a balance between greater individual empowerment and institutional development. It argues that the keys to regaining comprehensibility, manageability and meaningfulness in the Anthropocene lie precisely in embracing this wider, deeper, more entangled perspective.

Paradoxically, confronting the complexity of the scale of human impact on Earth systems and our multispecies interdependence can, over time, foster a robust form of comprehensibility. While initially unsettling, growing planetary sapience offers a more helpful way to understand our turbulent reality than explanations based on random misfortune, divine will or isolated system failures.

Understanding core concepts like biogeochemical cycles, planetary boundaries, ecological tipping points and feedback loops can replace chaotic bewilderment with systemic insight. These categories allow us to make sense of phenomena — from intensified wildfires linked to jet stream destabilization to ocean dead zones resulting from agricultural runoff — within a unified conceptual framework. Though difficult (and alarming), patterns emerge across superficially disparate events.

Restoring a sense of manageability requires shifting our focus from individual coping mechanisms or localized fixes towards collective, systemic action informed by this planetary understanding. While personal lifestyle changes retain ethical and symbolic importance, a planetary lens reveals that true leverage lies in transforming the macro-systems that drive the crisis: energy grids, industrial agriculture, transportation networks, financial markets and consumption patterns. It illuminates the actual scale at which resources — financial, technological, political, social, ecological — must be mobilized and demands met.

This perspective can counter individual feelings of helplessness by empowering collective action at strategic intervention points — developing regenerative agriculture, implementing circular economy principles, fostering transnational climate cooperation, restoring key ecosystems, building resilient local communities — that transcend individual limitations. Manageability is reconceptualized not as personal control, but as participation in collective efforts to navigate complex challenges, drawing on resources like ecological knowledge, community solidarity, technological innovation (wisely applied) and emerging forms of planetary governance.

Finally, and perhaps most crucially, embracing a planetary orientation can unlock sources of meaningfulness in an age teetering on despair. Confronting the Anthropocene not merely as an existential threat but as a defining collective civilizational passage can imbue actions, both small and large, with resonant purpose. 

Meaning will be found not in the illusions of the past but by participating in the work of shaping a viable future. It can be discovered in ecosystem restoration projects, climate justice advocacy, interspecies ethics and empathy research, building resilient local food systems or simply by seeking a deeper, more attentive connection with the living world in one’s own backyard. 

Engaging with the planetary predicament with courage and creativity, rather than succumbing to apathy or nihilism, will have to become the central meaning-giving task of our time. It offers a compelling narrative framework for action, oriented not toward a utopian endpoint but the deeply rewarding project of co-creating a habitable future.

Health As Planetary Participation

Planetary salutogenesis radically reframes health from a private experience or personal achievement to a distributed, participatory property of a flourishing, reciprocal relationship between human communities and the wider Earth system. It demands that our institutions — healthcare, public policy, education, economics, law, urban planning, culture itself — shed their anthropocentric blinders and outdated assumptions. It necessitates the deep integration of ecological literacy, systems thinking, Indigenous wisdom, environmental ethics and an ethos of planetary responsibility into every facet of how we understand and pursue well-being.

Cultivating a robust and resilient sense of coherence in the 21st century means learning to perceive, navigate and engage with our turbulent planetary reality. The urgent project of fostering human health and the essential task of healing our relationship with the planet are not separate agendas. They are one indivisible undertaking. The future of health will be planetary, or there will be no future health at all.