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Integrating Planetary Health in Health Guidelines (GRADE Guidance 46)
Thomas Piggott1, Pakeezah Saadat2, Alina Herrmann3
1Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, Ontario, Canada, and Department of Family Medicine, Queens University, Kingston, Ontario, Canada (T.P.).
Annals of Internal Medicine
|May 11, 2026
Summary
New guidance integrates planetary health into health recommendations. This ensures health systems protect both human well-being and environmental stability, addressing impacts on planetary boundaries.
Area of Science:
- Planetary Health
- Health Systems Research
- Environmental Health
Background:
- Human health is interdependent with natural systems.
- Current health guidelines lack methods to assess environmental impacts.
- Health interventions can negatively affect planetary boundaries (e.g., climate change, microplastics).
Purpose of the Study:
- To develop formal guidance for integrating planetary health into health recommendations.
- To address the gap in assessing health intervention impacts on planetary boundaries.
- To support evidence-based guideline development for individual and planetary health.
Main Methods:
- Established methods for GRADE guidance development.
- Iterative case study analyses and expert workshops.
- A 2-round global Delphi consensus process with four case studies.
Main Results:
- Formal GRADE guidance for incorporating planetary health was developed and approved.
- Guidance includes 7 domains, with highly desirable and optional items.
- Emphasizes systematic integration of planetary boundaries and equity in evidence-to-decision frameworks.
Conclusions:
- The guidance supports guideline developers and policymakers.
- Aims to protect both individual and planetary health.
- Maintains thoroughness and feasibility within the GRADE approach.
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