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[Comment] Offline: After 2000 years, an answer arrives

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The fabric of humanity is unravelling. That is not a 21st-century diagnosis of our collective ills. It was the conclusion drawn by Lucretius, a Roman poet whose epic De Rerum Natura (The Nature of Things) was published in the first century BCE. Divided into six books, Lucretius described the “architects of Death” as Disease and Pain. But he rooted his analysis of human life in the wider predicaments facing his society—“our land in her hour of need”. Lucretius linked prospects for the human condition to the state of Nature and the Earth, to the natural and physical systems on which human existence depended. In Book 1 of The Nature of Things, Matter and Void, he set out what he called the First Principle of Nature—“that nothing's brought forth by any supernatural power out of naught”. Or, put more prosaically, “Nothing can be made from nothing.” He was saying that the world we inhabit is all we have. We have no second chances. No spare worlds where we can escape should we irretrievably harm our current home. He observed that Nature's tendency is to reduce everything back to its elemental particles. That it is easier to destroy than to make. Lucretius celebrated the diversity of the natural and physical worlds and their fundamental unity through their common elements. It is only now, 2000 years later, that we are beginning to explore answers to our land in its hour of need.

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The truth is that my generation has failed to deliver on its promise to society. Only a new generation can truly repair the damage we and our predecessors have caused. At the heart of our difficulty is a crisis of trust. A crisis of trust in politics, in our economic way of life, and even in science and medicine. Why this trust deficit? In science and medicine, it is because we have focused too much on outputs and not outcomes. We have forgotten the injunction of the Enlightenment that knowledge is to be valued only to the extent that it advances the wellbeing of peoples and societies. Publishing papers in The Lancet may be a good start. But it is only a start. There are two parts to this indifference to outcomes. First, doctors and scientists have been too silent on the issues of greatest concern to citizens—from prosperity to inequality, from what we owe one another to the idea of a just society. Second, we have failed to realise the dividends of science for the lives of those living in the most deprived and marginalised communities. The crisis of trust is therefore worse—it is a betrayal. It is a betrayal that has contributed to the rise of populist and illiberal movements on every continent of the world.

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Some scientists are recognising the need for change. Last week, Giuseppe Remuzzi, Director of the Mario Negri Institute for Pharmacological Research, and Walter Ricciardi, Professor of General and Applied Hygiene at the Catholic University of Sacro Cuore, joined together to create the Italian Institute for Planetary Health (IIPH). The launch of the institute is a response to humankind and a planet in jeopardy. Something must change. And that change will only come if we change ourselves. The initial focus of the institute will be nutrition, based on our EAT–Lancet Commission on Food in the Anthropocene, our Commission on the Global Syndemic of Obesity, Undernutrition, and Climate Change, and our Series on the Double Burden of Malnutrition. The framing of planetary health is important because it links the public health threat of malnutrition with dysfunctional Earth systems that are shaping the future of humanity. It is significant that this new institute is being launched in Italy. Italy's long history of university scholarship and science, Mario Negri's commitment to defend health and human life, the impressive health indicators Italy enjoys thanks to a strong health system and relatively healthy lifestyles, and a culture that values broader determinants of human happiness—all of these characteristics will enable IIPH to offer Italy the opportunity for a new age of discovery. Lucretius saw human life as a constant struggle between creation and destruction. He worried that it was too late for Nature to provide for humanity. This new Italian Institute for Planetary Health intends to take up his challenge—and prove him wrong. Who will be next?

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