Josep Maria Antó’s research while affiliated with Pompeu Fabra University and other places

The emergence of the planetary health approach was highlighted by the report of The Rockefeller Foundation‐Lancet Commission on Planetary Health in 2015 and changed how we comprehend human well‐being. The report advocates integrating the health of other living beings and Earth's natural systems as intrinsic components of human health. Drawing on over three decades of experience in respiratory epidemiology and environmental health, this article outlines how my perspective on human health underwent a transformative shift upon reading the abovementioned report. The planetary health approach offers a lens through which human health issues and potential solutions can be understood within the context of the Anthropocene. It addresses the pressing existential challenges arising from humanity's transgression of planetary limits. Embracing the planetary health paradigm within the field of health sciences can catalyze transformative changes essential for cultivating a sustainable and equitable future.

The First European Planetary Health Congress, held from 5 to 7 July 2023 at ARTIS in Amsterdam, represented a significant milestone in the global movement of Planetary Health. The event brought together 121 attendees from academia and the private sector dedicated to addressing the impact of human disruptions to natural systems on the well-being of life on Earth. Co-organized by Natura Artis Magistra (ARTIS) and the European Hub of the Planetary Health Alliance (PHA), the Congress featured five workshops: The Future of Planetary Health Cities, Impact through Synergy, Planetary Health Education, Movement Building, and Food and Microbes. Oral presentations addressed the theme of how human health and the health of human civilization depend on the natural environment, including subthemes on Earth, Water, and Food. Additionally, the subtheme of Humans reflected on how humanity can thrive within Planetary Boundaries and how to imagine a prosperous future for all life on Earth. The First European Planetary Health Congress offered a platform for fostering sustainable, just, and equitable societies within ecological limits. Accordingly, ARTIS and the European Hub aim to shape a hopeful future for generations to come.

Background Understanding the natural history of abnormal spirometric patterns at different stages of life is critical to identify and optimise preventive strategies. We aimed to describe characteristics and risk factors of restrictive and obstructive spirometric patterns occurring before 40 years (young onset) and between 40 and 61 years (mid-adult onset). Methods We used data from the population-based cohort of the European Community Respiratory Health Survey (ECRHS). Prebronchodilator forced expiratory volume in one second (FEV 1 ) and forced vital capacity (FVC) were assessed longitudinally at baseline (ECRHS1, 1993–1994) and again 20 years later (ECRHS3, 2010–2013). Spirometry patterns were defined as: restrictive if FEV 1 /FVC≥LLN and FVC<10th percentile, obstructive if FEV 1 /FVC<LLN or normal otherwise. Five spirometry patterns were derived depending on whether participants never developed restrictive/obstructive (normal), developed restrictive/obstructive at baseline (young onset) or at last follow-up (mid-adult onset). The characteristics and risk factors associated with these patterns were described and assessed using multilevel multinomial logistic regression analysis adjusting for age, sex, sample (random or symptomatic) and centre. Results Among 3502 participants (mean age=30.4 (SD 5.4) at ECRHS1, 50.4 (SD 5.4) at ECRHS3), 2293 (65%) had a normal, 371 (11%) a young restrictive, 301 (9%) a young obstructive, 187 (5%) a mid-adult onset restrictive and 350 (10%) a mid-adult onset obstructive spirometric pattern. Being lean/underweight in childhood and young adult life was associated with the occurrence of the young spirometric restrictive pattern (relative risk ratio (RRR)=1.61 95% CI=1.21 to 2.14, and RRR=2.43 95% CI=1.80 to 3.29; respectively), so were respiratory infections before 5 years (RRR=1.48, 95% CI=1.05 to 2.08). The main determinants for young obstructive, mid-adult restrictive and mid-adult obstructive patterns were asthma, obesity and smoking, respectively. Conclusion Spirometric patterns with onset in young and mid-adult life were associated with distinct characteristics and risk factors.

Today we live in the Anthropocene, a new epoch characterized by the profound disturbances that industrial societies have caused in the Earth’s natural systems, resulting in an unprecedented existential threat to humans and most species. Planetary Health has emerged as a new interdisciplinary and transdisciplinary approach focused on understanding and addressing the impacts of human activities on natural systems and their consequences for human health and that of other species. Planetary Health adopts approaches from the sciences of complex systems to analyze the multiple interactions between social systems and natural systems and propose solutions to preserve the health of humans and other species within the sustainable limits of the Earth. Ethics is central to Planetary Health as it involves a strong focus on identifying the winners and losers from global environmental change and the need to protect the most vulnerable and future generations. Likewise, consistent with the timescale of the current transgression of planetary boundaries, there is a unique sense of urgency in Planetary Health to implement transformative mitigation and adaptation strategies.KeywordsPlanetary HealthEarth systemsSustainabilityPlanetary boundariesGlobal Health

Introduction: Adherence to controller medication is a major problem in asthma management, being difficult to assess and tackle. mHealth apps can be used to assess adherence. We aimed to assess the adherence to inhaled corticosteroids+long-acting β2-agonists (ICS+LABA) in users of the MASK-air® app, comparing the adherence to ICS+formoterol (ICS+F) with that to ICS+other LABA. Materials and methods: We analysed complete weeks of MASK-air® data (2015-2022; 27 countries) from patients with self-reported asthma and ICS+LABA use. We compared patients reporting ICS+F versus ICS+other LABA on adherence levels, symptoms and symptom-medication scores. We built regression models to assess whether adherence to ICS+LABA was associated with asthma control or short-acting beta-agonist (SABA) use. Sensitivity analyses were performed considering the weeks with no more than one missing day. Results: In 2598 ICS+LABA users, 621 (23.9%) reported 4824 complete weeks and 866 (33.3%) reported weeks with at most one missing day. Higher adherence (use of medication ≥80% of weekly days) was observed for ICS+other LABA (75.1%) when compared to ICS+F (59.3%), despite both groups displaying similar asthma control and work productivity. The ICS+other LABA group was associated with more days of SABA use than the ICS+F group (median=71.4% versus 57.1% days). Each additional weekly day of ICS+F use was associated with a 4.1% less risk in weekly SABA use (95%CI=-6.5;-1.6%;p=0.001). For ICS+other LABA, the percentage was 8.2 (95%CI=-11.6;-5.0%;p<0.001). Conclusions: In asthma patients adherent to the MASK-air app, adherence to ICS+LABA was high. ICS+F users reported lower adherence but also a lower SABA use and a similar level of control.

Plant species vary under different climate conditions and the distribution of pollen in the air and their trends can be used to assess the impact of climate change on public health. In 2015, MASK-air® (Mobile Airways Sentinel networK for rhinitis and asthma) was launched as a project of the European Innovation Partnership on Active and Healthy Ageing (EIP-on-AHA, DG Santé and DG CONNECT). This project aimed to develop a warning system to inform patients about the pollen season onset. SILAM (System for Integrated modeLling of Atmospheric composition), a global-to-meso-scale dispersion model was developed by the Finnish Meteorological Institute (FMI). It provides quantitative information on atmospheric pollution of anthropogenic and natural origins, particularly on allergenic pollens. POLLAR (Impact of Air Pollution on Asthma and Rhinitis, EIT Health) has combined MASK-air clinical data with SILAM forecasts. A new Horizon Europe grant, CATALYSE (Climate Action to Advance HeaLthY Societies in Europe; grant agreement number 101057131), which started in September 2022, aims at better understanding climate change and finding ways to counteract it. One objectives of this project is to develop early warning systems and predictive models to improve the effectiveness of adaptation strategies to climate change. One of warning system is focused on allergic rhinitis (CATALYSE Task 3.2). with a collaboration between the FMI (Finland), Porto University (Portugal), MASK-air SAS (France), ISGlobal (Spain), Hertie School (Germany) and the University of Zurich (Switzerland). It is to be implemented with the support of EAACI. This paper reports the planning of CATALYSE Task 3.2.