TY - JOUR
T1 - Integrating Planetary Health in Health Guidelines (GRADE Guidance 46)
AU - Piggott, Thomas
AU - Saadat, Pakeezah
AU - Herrmann, Alina
AU - Stein, Airton Tetelbom
AU - Darzi, Andrea J.
AU - Haines, Andy
AU - Bognanni, Antonio
AU - Sousa-Pinto, Bernardo
AU - Michels, Charlotte
AU - Akl, Elie A.
AU - Poluzzi, Elisabetta
AU - Senerth, Emily
AU - Madrid, Eva
AU - Barbic, Franca
AU - de’Donato, Francesca
AU - Nonino, Francesco
AU - Vist, Gunn Elisabeth
AU - Neumann, Ignacio
AU - Bracchiglione, Javier
AU - Bousquet, Jean
AU - Meerpohl, Joerg J.
AU - Antó, Josep M.
AU - Scahill, Karolina A.
AU - Qiu, Kavin
AU - Miersch, Klaas
AU - Saif-Ur-Rahman, K. M.
AU - Thinagaran, Lenny Vasanthan
AU - Benton, Lorna
AU - Schwingshackl, Lukas
AU - Siedler, Madelin R.
AU - Bala, Malgorzata M.
AU - Metzendorf, Maria Inti
AU - Aloosh, Mehdi
AU - Cinquini, Michela
AU - Cumpston, Miranda
AU - Skoetz, Nicole
AU - Oloyede, Oyekola
AU - Alonso-Coello, Pablo
AU - Dahm, Philipp
AU - Wang, Qi
AU - Vieira, Rafael José
AU - Morgan, Rebecca L.
AU - Murthy, Srinivas
AU - Hofstede, Stefanie
AU - Laot-Cabon, Sylvie
AU - Thomander, Tuuli
AU - Siebert, Uwe
AU - Leontiadis, Grigorios I.
AU - Schünemann, Holger
N1 - Publisher Copyright:
© 2026 American College of Physicians.
PY - 2026/6
Y1 - 2026/6
N2 - Human health and natural systems are intrinsically linked—stable natural systems enable healthy human life. Health systems aim to promote, restore, and maintain health. Health systems may promote human health while having detrimental effects on natural systems, contributing to the transgression of planetary boundaries, such as biosphere integrity, climate change, and the introduction of new entities like microplastics. To date, the health guideline field lacks methods to assess the impacts of health interventions on planetary boundaries. The GRADE (Grading of Recommendations Assessment, Development and Evaluation) Working Group established the Planetary Health Project Group in 2023 to develop formal GRADE guidance for integrating planetary health into guideline recommendations to address this gap. Guided by the concepts of planetary health and planetary boundaries and following established methods for GRADE guidance development, the project group conducted iterative case study analyses, expert workshops, and a 2-round global Delphi consensus process. Four case studies were selected for application of this guidance before recommendations were finalized. The GRADE Working Group approved the official guidance. The Planetary Health Project Group presents 7 domains of guidance for incorporating planetary health aspects into the guideline development process, including highly desirable items and optional items. Highly desirable items include formally addressing planetary health in public health and health system guidelines and explicitly justifying its exclusion where it is not addressed. Judgments within the evidence-to-decision (EtD) framework should systematically integrate included evidence across the prioritized planetary boundaries and equity. This guidance aims to support guideline developers and policymakers in making evidence-based, trustworthy recommendations to protect individual and planetary health, while maintaining thoroughness and feasibility for guideline developers within the GRADE approach.
AB - Human health and natural systems are intrinsically linked—stable natural systems enable healthy human life. Health systems aim to promote, restore, and maintain health. Health systems may promote human health while having detrimental effects on natural systems, contributing to the transgression of planetary boundaries, such as biosphere integrity, climate change, and the introduction of new entities like microplastics. To date, the health guideline field lacks methods to assess the impacts of health interventions on planetary boundaries. The GRADE (Grading of Recommendations Assessment, Development and Evaluation) Working Group established the Planetary Health Project Group in 2023 to develop formal GRADE guidance for integrating planetary health into guideline recommendations to address this gap. Guided by the concepts of planetary health and planetary boundaries and following established methods for GRADE guidance development, the project group conducted iterative case study analyses, expert workshops, and a 2-round global Delphi consensus process. Four case studies were selected for application of this guidance before recommendations were finalized. The GRADE Working Group approved the official guidance. The Planetary Health Project Group presents 7 domains of guidance for incorporating planetary health aspects into the guideline development process, including highly desirable items and optional items. Highly desirable items include formally addressing planetary health in public health and health system guidelines and explicitly justifying its exclusion where it is not addressed. Judgments within the evidence-to-decision (EtD) framework should systematically integrate included evidence across the prioritized planetary boundaries and equity. This guidance aims to support guideline developers and policymakers in making evidence-based, trustworthy recommendations to protect individual and planetary health, while maintaining thoroughness and feasibility for guideline developers within the GRADE approach.
UR - https://www.scopus.com/pages/publications/105042340095
U2 - 10.7326/ANNALS-25-04761
DO - 10.7326/ANNALS-25-04761
M3 - Article
C2 - 42114098
AN - SCOPUS:105042340095
SN - 0003-4819
VL - 179
SP - 874
EP - 884
JO - Annals of Internal Medicine
JF - Annals of Internal Medicine
IS - 6
ER -