Safeguarding Planetary and Human Health -Reflections on the Virchow Prize 2024

Ole Petter Ottersen^1,2Victoria Grandsoult^2*Roland Göhde²Detlev Ganten²

• ¹Department of Molecular Medicine, Institute of Basic Medical Sciences, University of Oslo, Oslo, Norway
• ²Virchow Foundation, Berlin, Germany

In this editorial, we briefly reflect on the Virchow Foundation and the Virchow Prize 2024 under the light of the outstanding contributions of last year's laureates, Lucy Gilson and Johan Rockström.More than ever do we need a multipronged approach to health. Reducing health to a purely biomedical issue has never been more misjudged. Socioeconomic status, education, and community support are crucial determinants of health, as are environmental influences and climate change. In fact, a quick glance at the United Nations 2030 Agenda Sustainable Development Goals (SDGs) tells us how important it is that we see human health in the context of animal and planetary health and that we are duly attentive to the structural and systemic causes of poor health. A comprehensive and multifaceted approach to health requires social and political solutions, implying that health and well-being must be seen in a system perspective that transcends the reach of the health care sector. Simply put: to care for health we must go beyond healthcare.The overarching motivation of the Virchow Prize is to promote "health for all" by honoring groundbreaking research, innovations, and other contributions towards the betterment of health on the global scale (Oni T., Ganten D., et al., 2023; Figure 1). "Health for all" implies reducing the health inequities that were deepened during the recent COVID-19 pandemic and that are now exacerbated by war and conflict, geopolitical tensions, erosion of multilateralism, and the rise of authoritarianism and protectionism. Importantly, "health for all" also emphasizes the need to care for the health of future generations. This is why the Virchow Prize is set to recognize achievements also in the realms of environmental and planetary health. We are on an unsustainable path that calls for collective action in the spirit of intergenerational justice. Crystallized in a few words: human health on a sick planet is a contradiction in terms.Between them, the two Virchow Prize 2024 laureates represent the broad approach to health that the Virchow Prize strives to support. Lucy Gilson has championed Health Policy and Systems Research which seeks to "understand and improve how societies organise themselves in achieving collective health goals, and how different actors interact in the policy and implementation processes to contribute to policy outcomes" while Johan Rockström has radically transformed our insight in the boundaries that define the planet's safe operating space. Together they have set the scene for continued efforts to safeguard health for current and future generations. Her scholarship emphasizes the relational elements of resilience, trust between health workers and communities, participatory governance, and inclusive leadership. These insights have deepened understanding of why some health systems can adapt to shocks while others collapse, as evidenced during the COVID-19 pandemic and Ebola outbreaks (Gilson L, Barasa E, Nzinga J, et al., 2017).Gilson's leadership in international consortia such as RESYST (Resilient and Responsive health systems) and the Emerald Project has shaped WHO guidance and strengthened capacity for HPSR across sub-Saharan Africa and beyond. Her focus on "everyday resilience" underscores the importance of supporting frontline staff and community actors as core drivers of adaptive capacity (Barasa E, Mbau R, Gilson L., 2018). Johan Rockström's research foregrounds the planetary boundaries framework, which identifies nine critical Earth system processes essential for maintaining the planet's stability. These boundaries, ranging from climate regulation and biosphere integrity to biochemical cycles, define the "safe operating space for humanity" (Rockström J, et al., 2009;Richardson K, et al, 2023).Rockström's early work with the Stockholm Resilience Centre and the Potsdam Institute for Climate Impact Research (PIK) demonstrated that multiple boundaries have already been breached, pushing Earth systems toward potentially irreversible tipping points. His more recent scholarship emphasizes how this environmental destabilization poses systemic risks to global health, including increased exposure to zoonotic diseases, food insecurity, and forced migration (Richardson K, et al., 2023;Steffen W, et al., 2015).Importantly, Rockström's contributions go beyond diagnostics. He promotes the "safe and just space for humanity" framework: integrating environmental ceilings with social foundations, thereby linking ecological sustainability to human equity (Rockström J, Sukhdev P., 2016; Raworth K, 2012). This has informed policy across UN agencies, the Planetary Health Alliance, and the Lancet Commissions. Hosting the Virchow Prize in Berlin underscores Germany's ambition as a global health convener (Ganten D., 2015). It also aligns with broader efforts to position Berlin as a hub for science-informed global health governance, exemplified by initiatives like the World Health Summit, the Global Health Hub Germany and the various activities in the area of international urban health. As we face the cascading challenges of climate instability, health inequities, systemic fragility and geopolitical tensions, the work of Lucy Gilson and Johan Rockström illustrates the importance of freedom of research, scientific collaboration, and the imperative of systemsbased public health in our efforts to improve health for all. Their scholarship illuminates paths toward resilience, both ecological and institutional, and calls on the global health community to bridge disciplines, embrace complexity, and act with foresight and compassion. Together Gilson and Rockström's pioneering approaches catalyze progress towards the Sustainable Development Goals while advancing equity for present and future generations and calling for a more resilient, healthier and just world.