COP15 and the Global Biodiversity Framework set out a roadmap for a whole-of-society approach to integrating nature and health
Today on World Health Day, the World Health Organization (WHO) is commemorating its 75th anniversary, and the year 2023 marks the 30th anniversary of the multilateral United Nations (UN) Convention on Biological Diversity (CBD).
As we enter the fourth year of the COVID-19 pandemic, there has been a growing recognition globally that the emergence of the virus was not an isolated incident. Rather, it is part of a pattern of epidemics coinciding with natural habitat destruction and resource exploitation. While our actions have led to climate change, biodiversity loss, and pandemics, we are also capable of changing course to a more sustainable trajectory and increasing political will and collective action to ‘make peace’ and reconnect with nature, as advocated by UNEP and UN Secretary General, Antonio Guterres.
Now more than ever, national governments, regions, cities, the private sector and other major groups need to address the interconnection of nature and health. As UN’s Environment Chief, Inger Andersen, mentioned, “At the end of the day, [with] all of these events, nature is sending us a message, […] We are intimately interconnected with nature, whether we like it or not. If we don’t take care of nature, we can’t take care of ourselves”.
The recent UN Biodiversity Conference (COP 15) held in Montreal in December 2022, and its landmark agreement, the “Kunming-Montreal Global Biodiversity Framework” (GBF), acknowledge the capacity and responsibility societies have to reduce biodiversity threats, foster the recovery of ecosystems, and establish effective measures for nature protection, thus promoting human health and wellbeing.
Why biodiversity is good for our health
Understanding the nexus
Human health and wellbeing depend on biodiversity in often unperceived and unappreciated ways. For example, most people attribute better health to the healthcare system. However, research indicates that only 20% of human health is attributable to clinical care and the remaining 80% depends on the social, economic, and environmental determinants of health.
In reality, there is a strong linkage between planetary and human health. The natural environment is a determinant of the health and wellbeing of people: healthy environments improve the health of humans, and indeed all life on Earth, whilst unhealthy or depleted environments can harm health. The WHO recognizes nature as “our greatest source of health and wellbeing” and that enhancing biodiversity is critical to recovery from the COVID-19 pandemic. Scientists have shown that spending time in nature goes beyond the psychological: ”Research suggests contact with microbes in the environment can “train” our immune systems and reinforce the microbial communities on our skin, in our airways and guts.” And more doctors are prescribing ‘time spent in nature’ to help in the recovery process and improve mental health: For example, clinicians in Japan have been recommending ‘shinrin yoku’, or ‘forest bathing’, since 1982, advising patients to get out and use the country’s 3,000 miles of woodland walks; in Canada and the USA doctors can issue ‘nature prescriptions’ giving patients access to national parks; and in 2020 the UK government committed £4 million ($5.2 million) to a two-year green-prescription pilot as part of its post-COVID-19 recovery plan.
Why does biodiversity matter to health? 
Biodiversity ensures food security and nutrition: Pollination is essential to food security generally and to the production of many of the most nutritious foods in particular. Pollinators play a significant role in the production of approximately one third of global food supply. Pollination also affects the quantity, nutritional content, quality, and variety of foods available.
Biodiversity helps fight disease: Higher rates of biodiversity have been linked to an increase in human health. 25% of drugs used in modern medicine are derived from rainforest plants. This means that every time a species goes extinct, we miss out on a potential new medicine. Also, Natural Protected Areas have been linked to lower instances of disease such as Lyme and Malaria.
Biodiversity underpins ecosystem functioning which provides services such as water and air purification: The Catskills Mountains, a forest reserve in New York, provides an estimated 1.3 billion gallons of drinking water to over 10 million residents daily. On the other hand, 20% of the world’s oxygen is created by the Amazon Rainforest, which means that the more trees we lose due to deforestation, the less supply of clean air in the world.
COP15 highlights related to biodiversity and health
The 196 Parties to the UN Convention on Biological Diversity, have called for increased engagement on biodiversity and health since 2008, when they requested a closer working-relationship with the WHO. At COP11 the Parties agreed to the establishment of a joint work programme with the WHO, in collaboration with relevant organizations and initiatives. During COP12 the CBD adopted its first full Decision on biodiversity and health; and COP15 raised ambitions by adopting a Decision on biodiversity and health (15/29) which builds on past Decisions. It encourages Parties and their subnational and local governments, to take action for a sustainable and inclusive recovery from the COVID-19 pandemic, which contributes to the conservation and sustainable use of biodiversity, and thereby contributes to minimizing the risk of future diseases of zoonotic origin, taking into account the One Health approach among other things.
The Kunming-Montreal Global Biodiversity Framework
The heightened ambition concerning biodiversity and health is also reflected in the GBF, which:
Acknowledges the right to a healthy environment and envisions a healthy planet for 2050;
Should be implemented with consideration of the One Health Approach, to aim for sustainable balance and optimize the health of people, animals, plants and ecosystems;
Recognizes the urgent need to reduce pressures on biodiversity and decrease environmental degradation to reduce risks to health, and, as appropriate, develop practical access and benefit-sharing arrangements;
Remarks on the need for equitable access to tools and technologies including medicines, vaccines and other health products related to biodiversity; and
Includes Target 12 to significantly increase the area, quality, and connectivity of, access to, and benefits from green and blue spaces in urban and densely populated areas sustainably, to improve human health and wellbeing, and connection to nature.
CBD Decision 15/29, encourages Parties and their subnational and local governments, and invites other Governments to;
Integrate the One Health approach in their national biodiversity strategies and action plans, and national health plans.
Support capacity building and development for mainstreaming biodiversity and health linkages.
Strengthen compliance with international and national provisions on access and benefit-sharing, in order to enhance the fair and equitable sharing of benefits arising from the utilization of genetic resources, as well as the fair and equitable sharing of benefits arising from the use of digital sequence information on genetic resources.
Nature and health profiled at COP15 side events
The emphasis on nature and health was also profiled at the following events:
An event themed “Unveiling the First Nature for Health Investments for Preventing Pandemics Together” introduced the Nature for Health (N4H) initiative, which aims to demonstrate the linkages between biodiversity, climate change, and pandemics to advance implementation of One Health at the national level.
The Subnational Governments and Cities Pavilion, hosted by ICLEI and co-hosted with the Secretariat of the Convention on Biological Diversity, and Regions4, along with the host the Government of Québec and the City of Montréal, and with the support and engagement of the Province of Yunnan and the City of Kunming, organized a session on “Health and wellbeing in cities: acting for access to green and blue spaces” which focused on GBF target 12.
The health sector: a critical partner of the biodiversity agenda
From a policy perspective, the health sector is a critical partner to biodiversity, because of its leverage to speed up, scale, and sustain the biodiversity agenda in reconnecting people to nature.
One leverage point is the access to human resources, as healthcare is one of the largest sectors globally. According to the World Health Organization, there are an estimated 12 million doctors in the world and more than 50 million other healthcare workers. So, considering the repeated calls by the CBD to effectively mainstream biodiversity across sectors, and the many CBD Decisions on biodiversity and health, the health sector has considerable influence that can be tapped into. Public health messaging occurs on a daily basis, and therefore it is an excellent channel to distribute biodiversity content and messaging.
Currently we are witnessing the potential of directly including biodiversity in the health sector day-to-day practice. Every day, millions of health practitioners are practicing the movement of “nature is medicine” and are providing medical prescriptions to their patients to visit parks for physical and mental health benefits. This practice has gained broad support within the medical community and received international recognition. This is a tangible, powerful example of how health professionals of the world can promote greater awareness among the general public of the benefits of reconnecting with nature.
Another advantage of collaborating with the health sector is by learning from the health sector, which has a strong evidenced-based approach. For example, health-based models for decision-making include basing decisions on the best available evidence, and considering aspects of equity, efficacy, and effectiveness. Of further interest, is the fact that collaborative messaging actually works. Indeed, research has shown that public support for policies improves when those policies are linked to both human and planetary health goals.
Most especially, successful implementation of GBF requires financial resources. While Investment in biodiversity conservation is considered inadequate and insufficient, global healthcare spending has risen steadily since 2000. A recent study revealed that 760-935 billion USD is wasted in the US healthcare system alone; global numbers go up to 1.5 trillion USD. That number is more than ten times the annual spending required to protect and restore biodiversity, and 20 times the amount society currently spends on the health of the environment. A strong case needs to be made to leverage greater investment in biodiversity conservation and urban nature from the health care sector, given its obvious benefits to both physical and mental health.
Researchers from Clemson University and Kaiser Permanente Northern California Division of Research, have found that nature’s benefits may include savings on health care costs, indicating that health care systems and medical insurance companies may spend hundreds of dollars less per person per year on medical care for people living in neighborhoods with the most green space, than they do on those living in areas with less/no trees, shrubs and grass: “Our study adds to the growing body of literature that has found living in greener areas is tied to beneficial short- and long-term health outcomes. The mechanisms linking nature and health are very diverse, but the benefits are believed to be in part because being in green space can decrease stress, promote healthy behaviors, and improve air quality”. Importantly, the study shows the value and benefits of encouraging public policy efforts to increase investment into more green space and urban greening for preventative health, as well as all the other collateral benefits green space has to offer.
From agreement to action: biodiversity governance within the One Health approach
COP 15 is categorized as a milestone in global biodiversity governance and its outcomes provide an important opportunity in connecting health stakeholders to agenda-setting and decision-making. As the GBF calls for a whole-of-society approach, it is important to recognize that safeguarding life on Earth requires collaboration between all levels of government, civil society, the business community, indigenous peoples, youth and other key stakeholders.
As the Parties move from agreement to action, the negotiations and policy agenda shifts to the subnational and local level to support implementation. Regions and cities are capable of transforming the CBD and WHO calls for “One planet, one health, one future” into tangible actions on the ground, because it is in urban environments that human, animal and ecosystem health, and the capacity for action and transformation have the closest connection and opportunity to create natural, healthy living spaces.
The One Health approach advocates the integration of the health of people, animals and ecosystems, by mobilizing multiple sectors, and disciplines at varying levels of society to work together to foster wellbeing and contribute to sustainable development. Governors and mayors recognize that as the level of government closest to communities, they are potential agents that shape human habitats in operationalizing the One Health approach.
Operationalizing a One Health approach at the local level 
Some practical recommendations include:
Map, innovate and scale up existing One Health initiatives and networks at the local level by conducting consultations to identify initiatives that successfully combine the multidisciplinary and intersectoral aspects of an approach encompassing humans, animals and the environment within and beyond the health system.
Strengthen the social component of One Health by building community engagement mechanisms to address the interface between humans, animals and the environment in an integrated manner: Listen, use and act on local voices to build trust and co-create community health and wellbeing.
Promote healthy urban planning by mainstreaming the One Health approach in urban planning, and by creating high quality green and blue spaces, and increasing urban greening and communal food garden initiatives in cities.
Join global initiatives such as CitiesWithNature and RegionsWithNature to share their experiences, learn from one another, and showcase their commitments and actions.
An example from theory to practice is Surrey County, (U.K.), which developed a 10-year “Health and Wellbeing Strategy” in 2019 that is based on scientific evidence and the citizens’ views. This strategy ensures ‘no one is left behind’ by using the approaches of ‘co-designing: deciding together and co-producing: delivering together’. It also focuses on building relationships with different community actors, and it has established clear governance mechanisms. After the onset of the COVID-19 pandemic, the strategy was updated to focus on prevention and to tackle the wider determinants of health, such as environmental and social factors to reduce health inequalities.
Today, in the mark of World Health Day, we celebrate the GBF call for increased recognition of the interconnection of the health of all species, rather than maintaining a traditional focus on human health.
COP15 marked a roadmap to build out a comprehensive and inclusive biodiversity-health action plan. Let’s keep on track!
 Carrington, D. (2020). Coronavirus: ‘Nature is sending us a message’, says UN environment chief. https://www.theguardian.com/world/2020/mar/25/coronavirus-nature-is-sending-us-a-message-says-un-environment-chief
 Delk, R. and O’Neill, T. (2018). “Understanding the Social Determinants of Health.” https://www.americanactionforum.org/research/understanding-the-social-determinants-of-health/#_edn8
 CBD, WHO. (2015). Connecting global priorities: biodiversity and human health: a state of knowledge review
 Earth Negotiations Bulletin. (2023). Unveiling the First Nature for Health Investments for Preventing Pandemics Together. https://sdg.iisd.org/news/cop-15-event-highlights-linkages-between-pandemics-and-biodiversity/
 ICLEI CBC. (2022). Program: Subnational Governments and Cities Pavilion. https://cbc.iclei.org/program-7th-summit-for-subnational-governments-cities/
 BC Parks Foundation. (2022). PaRx: A Prescription for Nature; BC Parks Foundation. https://www.parkprescriptions.ca/en/about
 Mantzari, E., Reynolds, J. P., Jebb, S. A., Hollands, G. J., Pilling, M. A., & Marteau, T. M. (2022). Public support for policies to improve population and planetary health: A population-based online experiment assessing impact of communicating evidence of multiple versus single benefits. Social Science & Medicine, 296, 114726.
 Shrank, W. H., Rogstad, T. L., & Parekh, N. (2019). Waste in the US healthcare system: estimated costs and potential for savings. Jama, 322(15), 1501-1509.
 Matthew H.E.M. Browning, Assistant Professor, Department of Parks, Recreation and Tourism Management, Clemson University in: https://www.news-medical.net/news/20220322/Natures-benefits-may-include-savings-on-health-care-costs-finds-study.aspx
 WHO. (2017). One Health. https://www.who.int/news-room/questions-and-answers/item/one-health
 WHO, European Region. Local-level policy recommendations: operationalizing a One Health approach. Political statement of the WHO European Cities Network.
 Health Surrey. (2022). Surrey Health and Well-being Strategy – update 2022.https://www.healthysurrey.org.uk/about/strategy/surrey-health-and-well-being-strategy-update-2022