Radical, transformative, or decolonial? A systematic review of The Lancet Planetary Health's progress on embracing...

All life on earth is affected by the intensifying impacts of climate change, biodiversity loss, and pollution. Planetary health science is emerging as a crucial framework to address the health of the planet and its inhabitants. Indigenous Peoples' knowledge systems have evolved over millennia and are grounded in principles such as interconnectedness of all living things. As a discipline, the tenets of planetary health draw upon Indigenous science and approaches; however, the extent of ethical engagement has not been examined. We conducted a systematic review of all articles published in The Lancet Planetary Health up to October 2025, to assess the recognition and integration of Indigenous knowledge systems. 1137 of 1172 articles reviewed contained no Indigenous research features or perspectives. Although the number of articles engaging with Indigenous knowledge systems has increased over time, these publications are predominantly commentaries, with relatively few original research articles. The Lancet Planetary Health was launched with the aim of informing a "radical civilisational transformation". Based on the findings of this systematic review, we suggest that decolonising planetary health science should be integrated into this civilisational transformation.