A recent study from the US showed that in 2013 the health care sector was ‘responsible for significant fractions of national air pollution emissions and impacts, including acid rain (12%), greenhouse gas emissions (10%), smog formation (10%), criteria air pollutants (9%), stratospheric ozone depletion (1%), and carcinogenic and non-carcinogenic air toxins (1–2%)’ (Eckelman and Sherman, 2016).

‘The impact of human activities on our planet’s natural systems has been intensifying rapidly in the past several decades, leading to disruption and transformation of most natural systems. These disruptions in the atmosphere, oceans, and across the terrestrial land surface are not only driving species to extinction, they pose serious threats to human health and wellbeing. Characterising and addressing these threats requires a paradigm shift’ (Myers, 2017).

‘action at the level of direct drivers of nature decline, although necessary, is not sufficient … a sustainable global future’ is ‘only possible with urgent transformative change that tackles the root causes: the interconnected economic, socio-cultural, demographic, political, institutional, and technological indirect drivers behind the direct drivers’ (Diaz et al., 2019)