China-U.S. Scientific Engagement: Key Issues and Possible Solutions for Sustainability and Planetary Health

Proceedings of a Workshop—in Brief

Scientists in China and in the United States have worked collaboratively, both formally and informally, for years to address their shared sustainability challenges. To further this engagement, the U.S. National Academies of Sciences, Engineering, and Medicine (the National Academies) and the Chinese Academy of Sciences (CAS) are convening a workshop series to examine the state of sustainability research and practices, identify priority areas for scientific collaboration on specific sustainability challenges, and discuss opportunities for mutual scientific exchange and cooperation in China and the United States. The first workshop was held July 27–29, 2022, and focused on sustainability and biodiversity as an important area of sustainability research and practices.

The second workshop, held on June 20–21, 2023, focused on identifying priority areas for scientific collaboration to promote sustainability and planetary health in China and the United States. Participants gathered at the National Academies Beckman Center in Irvine, California, as well as virtually to discuss a subset of the field, including (1) ecosystems and planetary health; (2) air pollution and planetary health; (3) urbanization and circular systems towards planetary health; (4) planetary health, health emergencies, and climate change; and (5) key priorities and international cooperation for planetary health.

Participants discussed a wide range of topics, including the importance of promoting education for future generations around planetary health; understanding the intricate relationships between ecosystems and human health for scientific policymaking; implementing measures to reduce emissions and improve air quality; embracing sustainable urbanization and promoting circular economy practices; addressing health emergencies and mitigating the adverse effects of climate change on planetary health; and supporting a transdisciplinary workforce towards achieving sustainability and planetary health in China and the United States. The final session included a discussion of possible future steps and opportunities based on the workshop discussions and is summarized in the section on Path Forward: Future Needs and Opportunities.

WELCOME AND INTRODUCTIONS

Marcia McNutt (NAS), President of the National Academy of Sciences, provided introductory remarks and offered her appreciation for the continued opportunity for important interactions between the two countries' scientific communities. She discussed the focus of the second workshop, to examine emerging issues of planetary health and sustainability, while taking advantage of the momentum gained through the

U.S.-China Joint Glasgow Declaration on Enhancing Climate Action in the 2020s.¹ According to the 2023 National Academies publication, Integrating Public and Ecosystem Health Systems to Foster Resilience, “connections between people and their environments are under stress from human-driven climate change, pollution, resource exploitation, and other actions that may have implications for public health.”² U.S.-China scientific collaborations and leadership will be critical to advising policy actions with a solution-focused approach to promote planetary health and sustainability.

Zhenyu Wang, Bureau of International Cooperation, CAS, read the letter of welcome by CAS President Jianguo Hou. Dr. Hou said in the letter that supporting planetary health requires global cooperation and coordinated action along with cross-sector research. China has played an active role in addressing key global challenges such as climate change, biodiversity loss, and natural disasters. The partnership between the two organizations has been vital. “By walking together, we can better understand the capacity of our planet and find our path to a better future,” Dr. Hou stated in the letter.

Introductions and Goals of the Workshop Series

Workshop co-chair Karen Seto (NAS), Yale University, discussed the history of the collaboration between the National Academies and CAS, which began in 2018 with the Symposium on Science and Technology Innovation for Sustainable Development Goals, held in China. In 2019, the National Academies hosted a second workshop on urban sustainability in the United States. While the pandemic halted in person convenings, the two countries kept in close communication and in 2022, the National Academies established the Subcommittee on U.S.-China Scientific Engagement to explore joint work in specific areas of global importance. Conversations within the Subcommittee lead to the development of the workshop series, to focus on promoting scientific coordination, cooperation, and collaboration between China and the United States on sustainability issues, including around the United Nations’ Sustainable Development Goals (SDGs).

Yongguan Zhu (CAS), workshop co-chair and Research Center for Eco-Environmental Sciences, CAS, also highlighted the value of the collaboration between the two counties, noting that while the United States and China have different pathways of economic development and research, “we have the same goals to achieve planetary health.” Dr. Zhu described current collaborations between U.S. universities and the CAS, including a project with Stanford University where researchers are studying ecosystem health using China as a living laboratory. The project will ultimately result in research hubs being established around the globe. The hope for this initiative is to identify solutions to global sustainability challenges, identify ways to train a younger generation of scientists from both countries, and to walk together in a multicultural environment to further knowledge of planetary health.

FRAMING REMARKS: THE STATE OF PLANETARY HEALTH AND SUSTAINABILITY

Speakers during this session discussed the emerging field of planetary health and sustainability in their home country. Howard Frumkin (NAM), University of Washington School of Public Health, who discussed the state of planetary health in the United States, began by defining the term as:

Planetary health is an aspirational state and a scientific framework, one that fuses biomedical sciences with physical, environmental, and social sciences, Dr. Frumkin said. It is also a future-focused, emerging scientific field, and a social movement committed to protecting earth systems for equitable human well-being. Planetary

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health calls for a reset of many of our economic and social arrangements based on shared concepts of justice and fairness. Dr. Frumkin traced the rapid growth of Planetary health in recent years, as evidenced by citations, academic programs, media attention, and other indicators. He suggested five under-researched topics for further exploration, filling evidence needs to: (1) bolster mental health in the face of global challenges; (2) better predict migration and resettle people in healthy ways; (3) examine and improve food systems from production through consumption; (4) design and create sustainable, healthy built environments, from the building scale to the metropolitan scale; and (5) elevate successful policy levers to achieve planetary health in the long term.

George Fu Gao (NAS/NAM./CAS), Institute of Microbiology, CAS, discussed the need for science, collaboration, and common sense in developing solutions to critical global sustainability challenges. He discussed the COVID-19 pandemic as an example of a global challenge requiring significant international collaboration. The pandemic elevated the importance of the One Health concept, or the interconnectedness of animal, human, and environmental health. It also highlighted the need for solidarity and the role of science in developing solutions. The global sharing of data on the virus’s genome sequence allowed for rapid development of vaccines and diagnostic kits. As a result, there are now enough vaccines for the whole world. Dr. Gao noted that there is a need for various sectors to work together to address global challenges, including future global epidemics and pandemics, which are imminent. Dr. Gao discussed that collaboration is essential to supporting planetary health and sustainable development.

Discussions The State of Planetary Health and Sustainability

Participants discussed policy interventions that could be implemented in the near term to address planetary health challenges, including decarbonizing the global economy and funding key research collaborations to break down silos. Reexamining institutional structures at universities and focusing on the training of the next generation were also discussed. Dr. Gao reiterated the need to focus on education for future generations around planetary health, including related to big data.

Freshwater systems must also be a key consideration in planetary health, one participant noted. Water is a political issue—it is now a commodity priced on private markets rather than delivered as a public good. There is a need to understand how to better manage water resources as equitably and sustainably as we can, Dr. Frumkin stated. Another participant discussed the critical importance of data sharing, including the role of industry. Both Drs. Gao and Frumkin noted that we cannot make progress on planetary health without engaging industry. Dr. Frumkin added that the incentives that are built into industry need to be reexamined. “There’s a very big transition ahead of us,” Dr. Frumkin said.

PANEL I: ECOSYSTEMS AND PLANETARY HEALTH

During the first panel, Jianguo “Jack” Liu, Michigan State University and Keping Ma, Institute of Botany, CAS served as moderators to discuss issues related to ecosystems and planetary health.

John Drake, University of Georgia, discussed planetary health and the emergence of infectious diseases. The obstacles to health differ among populations, and thus, the solutions for individual and group health differ. Socioeconomic factors are also central determinants of health outcomes. Planetary health recognizes that civilization depends on human health, flourishing natural systems, and stewardship. With planetary health, one begins to think about health as sustainable, meaning there is a need to consider equity, governance, and participation so that the institutions and processes that put health at risk are also part of the solution.

Dr. Drake discussed his research on spillover risk of infectious diseases from animals to humans, including the Ebola outbreak in Central Africa. Data indicate that spillover intensity is highest during transitions between wet and dry seasons and at high and very low human population densities. Important to planetary health is the idea that the distribution of the human population is also relevant to spillover. Dr. Drake also discussed a systems-of-systems approach to modeling planetary health (see Figure 1). He stated that planetary health must consider interactions at all scales, from the individual to the

meta-population, to the interactions among the planets. Individual health is dependent on the health of the planet, and in tum, the health of the planet is dependent on the health of individuals and societies.

Christine Petersen (NAM), University of Iowa, discussed her research on the use of ecosystems to intervene with infectious disease. She described the work of her team to examine the vector-borne disease carried by the sandfly, Leishmania infantum.⁴ This neglected tropical disease is found in 90 countries. In studies of dogs who carry this disease, researchers found that the skin surface of dogs with subclinical or mild disease appear to be the most infectious compared to dogs with severe disease. Researchers tested the use of medicated collars on dogs to slow or limit human infection and found this solution was quite effective and did not require behavior change.

A similar solution to addressing Lyme disease is being studied in Maryland, Dr. Petersen added. Researchers are developing a reservoir-targeted vaccine against Borrelia burgdorferi to prevent Lyme disease transmission. The vaccination of secondary hosts (e.g., mice and dogs) has been found to reduce the spread of the disease. These studies demonstrate that ecologies can support efforts to stop the spread of infectious diseases and can be utilized in new innovative ways to work across fields to change the outcome of human and animal health.

Yonglong Lu, Xiamen University, discussed spatial variation in biodiversity loss and ecosystem health. Multiple stresses and biodiversity loss are spatially-related, and climate change and human activities are likely the fundamental force driving these issues. Disasters caused by climate change and industrial activities also have marked effects on local species distribution and population size. Dr. Lu discussed research examining the effect of urbanization on biodiversity through studies of birds. The distribution of threatened birds has a strong seasonal variability and urbanization has a significant impact on the threatened species. However, birds that can adapt to the urban environment are less affected by human activities.

Pollution-related health problems in China are significant, Dr. Lu said. Nearly 60 percent of “cancer villages” or communities with high rates of cancer are located less than 3 kilometers from a major river. About 95 percent of cancer villages in China have high exposures to chemical carcinogens. He stressed the importance of collaboration in further examining these issues.

Hua Zheng, Research Center for Eco-Environmental Sciences, CAS, stated that ecosystems provide many benefits for humans, including provisioning services, such as food, freshwater, wood and fiber, and fuel. Climate change has had a significant impact on ecosystems and human health. With climate change, there is increased exposure to extreme heat as well as

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sandstorms, both of which have significant impacts on human health. Dr. Zheng also discussed the important role of the environment in mental health and the need to further study this issue.

Dr. Zheng described a conceptual framework for integrating ecosystem services and human health by classifying different types of services, for example, product transfer, matter cycle, energy flow, and information delivery. By examining ecosystem properties, the ecosystem service supply, and quantifying exposure, one can use the framework to assess how integrating ecosystem services and human health impact different groups.

Discussion: Ecosystems and Planetary Health

Participants discussed the importance of assessing planetary health “tipping points.” As we develop increasing technologies to collect these data, there will be opportunities to use algorithms to support an analysis of these complex systems, one participant noted. Another participant said that there is a need for long-term research and data to assess tipping points as well as a focus on spatial scaling issues that can support this kind of analysis. Conducting research on planetary health issues is difficult given that most funding available is time limited and long-term data and collaborations are needed, said one participant.

PANEL II: AIR POLLUTION AND PLANETARY HEALTH

Ashok Gadgil (NAE), University of California, Berkeley and Zimeng Wang, Fudan University moderated the second panel addressing the intersection of air pollution and planetary health.

Veerabhadran Ramanathan (NAS), University of California, San Diego, discussed the interconnection between air pollution, climate change, and climate resilience, highlighting the need for air pollution and climate change to be considered as an integrated issue. According to the Intergovernmental Panel on Climate Change, it will be beyond our ability to adapt to climate change by 2050, so it is imperative that we take action today. The significant barrier to making progress in addressing climate change is human behavior.

We must rethink our approaches to climate change and air pollution, Dr. Ramanathan said. over the next 10 to 15 years, there is a need to move toward a fossil fuel free society with a focus on the unmasking of warming. Reducing short lived climate pollutants, such as methane, hydrofluorocarbons, ozone, and black carbon, must also be a focus. Also, changing the narrative around climate change to highlight human health and welfare may spur further action in the United States where there have been political barriers to climate policy, Dr. Ramanathan noted.

Cesunica Ivey, University of California, Berkeley, discussed the role of consumerism and international trade in air quality, climate, and sustainability challenges, noting that the United States and China emit the majority of greenhouse gases and pollutants globally. Dr. Ivey discussed a 2019 study of U.S.-China bilateral shipping activity which indicated that for U.S. exports, 59 percent of total emissions originate from transport activities; nearly all of these occur in regions outside the United States and China. Also, 34 percent of the premature deaths caused by shipping emissions occurs in countries not directly related to the U.S.-China bilateral trade.⁵ U.S. demand for Chinese exports has also been linked to excess mortality.⁶

Both U.S. and Chinese residents are directly affected by pollution associated with consumerism, manufacturing, and trade, Dr. Ivey noted. There is a need to reduce demand for goods that require long-distance transport and non-local manufacturing. Climate change will worsen the effects of air pollution from goods movement and consumerism through accelerated atmospheric chemistry (higher temperatures). As Dr. Ivey noted, “our unbridled capitalism and the desire for things we don’t need to survive is unsustainable.”

Hongliang Zhang, Fudan University, discussed the role of natural originated emissions in threatening future

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air quality goals. Air pollution is severe worldwide, as evidenced in Figure 2. Controlling emissions is the only mechanism for reducing air pollutants. Natural sources of emissions include lightning, volcanoes, windblown dust, and wildfires, while anthropogenic sources include power generation, airplanes, mobile transport, industries, and residential activities.

Natural sources of pollutants are changing, mostly increasing, due to higher temperatures, less wind speed, humidity and droughts, land-cover changes, stronger lightning, and the lower boundary layer height in future climate. Dr. Zhang suggested that it is important to consider the synergetic impacts of pollutants to meet World Health Organization’s new air quality guidelines and formulate strategies to work together between China and the United States.

Tong Zhu (CAS), Peking University, discussed the importance of coordinating air pollution control and climate change mitigation policies to maximize the health benefits. Most cities have experienced severe air pollution, a growing problem. He cited the impact from the recent wildfires in Canada on air quality around the globe. With global warming, there is also a higher potential for forest fires.

Heat and air pollution can also create synergistic health effects. For example, exposure to ozone in high heat has been found to increase the risk of mortality. Thus, considering the synergistic health effects of air pollution and high temperatures resulting from climate change is important. Dr. Zhu stated that there is a need to focus on reducing the health effects related to climate change as well as elevate the health benefits of these to address pollution. Connecting scientists, policymakers, and stakeholders in these discussions is a critical step.

Discussion: Air Pollution and Planetary Health

Participants reiterated the point that if we rapidly reduce air pollution, there is the potential of unmasking and accelerating climate change. Therefore, there is a need to both reduce air pollution and fossil fuel consumption simultaneously. If only one area is addressed, there is the potential to amplify the other. Participants discussed the health implications resulting from the overconsumption of goods in the United States. A mindset shift is needed at the individual, collective, and industrial level. Reducing human consumption through behavior change may take decades, therefore, there is a need to focus on promoting alternatives immediately, one participated added.

PANEL III: URBANIZATION AND CIRCULAR SYSTEMS TOWARDS PLANETARY HEALTH

Steward Pickett (NAS), Cary Institute of Ecosystem Studies and Weiqiang Chen, Institute of Urban Environment, CAS moderated the third panel focusing on urbanization and circular economy strategies to address sustainability and planetary health.

Marian Chertow, Yale University, discussed collaborative efforts between the United States and China to develop the field of industrial ecology, citing a quote about the field:

Dr. Chertow discussed the role of the National Academies in developing the field, particularly a seminal conference the organization held in 1991. Subsequently, the United States and China convened 50 professors from 30 universities at Tsinghua University to discuss education in industrial ecology. The workshop resulted in dozens of programs in China and Asia related to industrial ecology, as well as scholarship programs and teaching exchanges.

The concepts of resource conservation and waste circularity are integral to industrial sustainability and are areas that the United States and China could continue to collaborate, Dr. Chertow stated. Other future collaborative projects could include developing related courses, such as tools of industrial ecology, material flow analysis, and life cycle assessment, along with joint projects on circularity and eco-industrial parks to address continuous improvement.

Xiaobo Xue Romeiko, University at Albany, State University of New York, discussed circular food and water systems for environmental sustainability and public health. She began by providing some context for her research on a food rescue project for environmental sustainability. Forty percent of food is wasted before consumption, which costs about $218 billion per year in the United States. Food security is also a significant issue with about 1 in 8 Americans struggling to put food on the table; only about 3 percent surplus food ends up being donated.

Dr. Romeiko’s research team created an interdisciplinary framework to quantify the environmental, nutritional, and health impacts of food recovery and redistribution systems. The researchers collaborated with local emergency organizations to gather information about food donation and to assess micronutrients being rescued through food redistribution and recovery. Researchers also examined chronic disease rates as related to intake of fruit and vegetables and the environmental health impact of related policies, programs, and interventions. Dr. Romeiko’s team found that improving the quality of donated food had benefits as did reducing transportation distances which minimized related air pollution. If food waste was diverted from landfills and repurposed, the benefits further increased. In terms of health benefits of the food donation systems, Dr. Romeiko’s team found that increased vegetable intake reduced hypertension rates and body mass index; increased fruit intake was protective against diabetes. Thus, circular food systems not only reduce carbon emissions, but also promote public health.

Dr. Romeiko discussed that multi-disciplinary collaborations are necessary to reveal the possible co-benefits and tradeoffs among environmental health metrics. Cross-site and nation comparisons and multiscale assessment are needed to understand the impacts of circular systems. Finally, stakeholder engagement and partnerships play a key role in designing and implementing circular systems.

Tao Lin, Institute of Urban Environment, CAS, stated that human activities are the major drivers of biogeochemical processes at the local, regional, and global scales. In urban systems, there is nutrient urban metabolism following food consumption and waste management. The characteristics of urban nutrient metabolism and cycling

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are dominated by humans and are high density and low eco-efficiency.

Dr. Lin discussed the carbon nitrogen phosphorus urban establishment process within Xiamen City, China. The city has experienced significant population growth since the 1990s which has contributed to nutrient problems. In an analysis of the sensitivities of controlled variables in the fate of food-sourced carbon, nitrogen, and phosphorus (CNP), Dr. Lin noted that enhancing current waste treatment can only alter the emissions directions. Different treatments have different capabilities to adjust the food sourced CNP emissions. Mitigating one pathway will intensify the others. Urban systems cannot resolve the nutrient problem by themselves.

He also discussed the nutrient circular system in terms of coupling the urban and rural systems. Rural systems can be considered a footprint ecosystem that supply resources and consume the waste from the urban systems. Urban and rural systems should be coupled to address their shared environmental challenges. Dr. Lin emphasized that solutions should focus on different scales-local, regional, and global, and waste treatment and circular techniques should be the priority for the local, regional, and global scales. Solutions for sustainable, nutrient circular system covering urban and rural system should be integrated and should work together at the different scales, Dr. Lin concluded.

Jianqiang Su, Institute of Urban Environment, CAS, discussed anthropogenic impacts on antimicrobial resistance in the environment. By 2050, it is estimated that human deaths due to antibiotic resistance may exceed those deaths attributed to cancer. Dr. Su discussed that microbes and antibiotic resistant genes (ARGs) can be transmitted between humans, animals, and the environment. Wastewater treatment plants and livestock farms are hotspots for antimicrobial resistant bacteria and ARGs. The application of manure or compost at livestock farms leads to enrichment of ARGs in soil, while at wastewater treatment plants, the discharge of effluent and sludge is the primary source of ARGs.

In 2010, the Chinese government gradually closed farms near waterbodies, including along the Jiulong River. In a 9-year surveillance study of the river, Dr. Su found a significant decrease in total ARG abundance. The reduction of ARGs could be attributed to the closure of farms near the river. To address AMR in the environment, Dr. Su noted that there is a need to promote awareness and incorporate environmental considerations into national action plans on AMR. Improved environmental surveillance and monitoring systems and an evaluation of the impact of chemical pollutants on the evolution and spread of AMR are also important. Developing or optimizing technology for wastewater treatment and waste treatment can reduce AMR. Finally, Dr. Su stated that translating current knowledge into environmental legislation is also critical.

Discussion: Urbanization and Circular Systems towards Planetary Health

Participants discussed the benefits of green space, including the need for research to assess the health benefits of these spaces. Green space can address stormwater overflow and reduce greenhouse gas emissions of stormwater treatment. The co-location of food production and the food consumption in urban centers can serve as an important solution to several urban sustainability challenges, participants noted. Participants discussed that there is a need to redesign food systems for future cities, and nature-based solutions that address some of the challenges facing the food systems should also be considered for the urban environment. Participants also discussed the need to focus on the system as a whole in considering planetary health, particularly as subcomponents are interconnected in both time and space. One participant reinforced the need to break down the silos that exist between scientific communities to contribute to these scientific solutions.

PANEL IV: PLANETARY HEALTH, HEALTH EMERGENCIES, AND CLIMATE CHANGE

Judith Wasserheit (NAM), University of Washington, and Yi Shi, Institute of Microbiology, CAS, moderated the fourth panel focusing on climate change and health emergencies.

Andrew Haines (NAM), London School of Hygiene and Tropical Medicine, discussed the health effects of climate change and of adaptation and mitigation actions. Greenhouse gas emissions are concentrated in high-income and emerging economies. Low and middle-income countries are disproportionately affected by climate change in general, but all countries, regardless of income, are now experiencing the impacts of climate change. Dr. Haines described the various exposure pathways through which people experience adverse health outcomes related to climate change, such as increased frequency and/or intensity of extreme weather events, heat stress, air pollution, and reduced freshwater quantity and quality, among others. These exposure pathways can have severe and wide-ranging effects on health outcomes (see Figure 3). Climate change also affects labor productivity. As temperatures increase, it can become more difficult to work, particularly for those who work outdoors. This will drive millions, and possibly billions, into poverty.

Extreme heat may have a significant impact particularly on vulnerable populations such as the elderly, Dr. Haines stated. Rising temperatures and population growth have also contributed to increases in vector-borne diseases in some locations, including malaria and dengue. Reductions in crop yield can increase food insecurity and the risk of undernutrition, especially in low-income populations. National and sub-national governments can take action to adapt to and mitigate climate change. For example, city leaders can support accessible, efficient public transport; offer universal access to clean low carbon energy; create safe green spaces and ecosystem strategies for resilience; and encourage energy-efficient and climate-resilient housing improvements.

The burning of fossil fuels and food production systems account for over 90 percent of greenhouse gas emissions and greatly impact human health. Climate change mitigation solutions can therefore also bring a range of different health benefits, both by reducing the health risks of climate change and through near-term

co-benefits, for example from reduced air pollution, promoting more sustainable dietary choices, and increased physical activity. Thus, promoting clean renewable energy, developing sustainable transport systems, encouraging dietary changes, including reducing the consumption of red and processed meat, and reducing greenhouse gas emissions in the health care sector are critical actions. Dr. Haines also noted that nature-based solutions (e.g., forest conservation and reforestation, wetland protection) can make a substantial contribution to the cost-effective climate mitigation needed between now and 2030 to stabilize warming to below 2 degrees Celsius.⁸

Jue Liu, Peking University discussed that over the past 60 years, there has been a change in the climate suitability for infectious disease. COVID-19 provides such an example. The pandemic greatly impacted work to address the SDGs. More than four years of progress against poverty have been erased as a result. The global poverty rate increased sharply from 2019 to 2020, from 8.3 percent to 9.2 percent, the first rise in extreme poverty since 1998 and the largest since 1990.⁹ The COVID pandemic also deepened a global learning crisis, Dr. Liu said; nearly 147 million children missed over half a year of in-person instruction.

To address the significant challenges related to climate change, Dr. Liu noted the need to transition to clean and renewable energy, reduce carbon emissions, and enhance biodiversity conservation and ecosystem protection. To prevent a future pandemic, there is also a need to establish resilient health systems; strengthen disease surveillance, preparedness, and response; raise public awareness; and promote behavioral change. Enhancing global cooperation is needed above all.

Yongqin Liu, Institute of Tibetan Plateau Research, CAS, discussed the glacial microbiome and ecosystem sustainability. Glaciers are significantly impacted by climate change. The Antarctic, Arctic, and Tibetan Plateau are warming quickly and as a result, the global glaciers are retreating rapidly. In addition to the important influence of glaciers on global hydrology, glaciers also serve as a biome host for diverse microorganisms, Liu said. In a recent publication, over 900 novel bacterial species and 40 million genes are identified from 21 Tibetan glaciers, and these numbers are expected to be much higher at a global level. Therefore, the warming of the glaciers will lead to biodiversity and function losses.

Dr. Liu discussed research on the impact of glacier microbiome on downstream ecosystems and human health. Glacier stores ancient viruses deposited as old as 14,000 years ago. Dr. Liu identified more than 10,000 DNA viruses from global glaciers, most of which are bacterial phages, while those with potential human pathogenicity (such as herpes virus) are extremely rare. Therefore, glaciers can be considered a safe reservoir of ancient and modem viruses. Nevertheless, diverse antibiotic-resistance genes, which are considered emerging biocontaminants, are identified in glacier and their release from glaciers are more problematic.

Dr. Liu stated that evaluating the impact of glacier microbiome under climate change requires an understanding of what microorganisms are being released, including how warming and melting impact the biochemical cycle and greenhouse gas emissions, and how the release of microorganisms may impact ecosystems. There is also a need to assess how global glaciers differ in their response to climate change. On April 26, 2023, the Chinese government passed legislation to protect the ecosystems of the Tibetan Plateau. The large ice cap and groups of smaller glaciers are now protected from human disturbance. Dr. Liu noted that evaluating the impact of the glacier microbiome will be an important next step, so that similar legislation could be implemented at a global level.

James K. Boyce, University of Massachusetts Amherst, discussed how to allocate scarce climate adaptation resources given that vulnerability to climate change will not be distributed uniformly across the world. He introduced the work of the Green Climate Fund, created to channel resources towards climate adaptation. The

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Fund will operate in a transparent and accountable manner guided by the principles of efficiency and effectiveness. He highlighted the difference between efficiency and effectiveness—effectiveness is choosing the means to achieve a given end (e.g., saving lives) at the least cost, while efficiency is choosing “the ends” as well as the means by weighing benefits against costs (e.g., comparing the monetized value of human lives to the costs of saving them).

Dr. Boyce noted that the few studies of how adaptation resources have been allocated have found that resources often are allocated to advance the agendas of powerful groups at the expense of marginalized populations. This can occur through displacement of impoverished rural populations in the name of climate change adaptation, which then frees up their lands and other resources for appropriation by more powerful groups.

When considering the allocation of scarce resources for adaptation, there is a question of what underlying values should guide these decisions. The wealth-based answer is that we should be guided by efficiency, which holds that we should protect the most valuable people, property, and resources. However, the rights-based answer is that we should be guided by the values of environmental justice, where we protect the most vulnerable people. There is a disconnect between the so-called most valuable and the most vulnerable populations. The most vulnerable people tend to be the people with the lowest wealth and have the least political power. Therefore, if adaptation is guided by business as usual, many of the vulnerable people will be left out in the allocation of resources, even though they have the most to lose. If we want to protect all people, there is a need to re-examine our values and advance the goal of environmental justice, Dr. Boyce stated.

Discussion: Planetary Health, Health Emergencies, and Climate Change

Participants discussed what actions could be taken to stimulate movement on climate change and health. Dr. Haines noted that the connection between climate change and health has only very recently been widely acknowledged. Raising the profile of this issue is a key step. Countries file a nationally determined contribution report through the Paris Climate Agreement to document their commitment to addressing climate change. Asking governments to make health more central in nationally determined contributions will be important along with working to ensure that climate change is a higher priority in climate negotiations.

Participants also discussed ways to protect vulnerable populations from the impact of climate change through adaptation. Dr. Boyce noted that it is important for those who have a seat at the table to use their voice to advocate and build public awareness about these issues. Elevating the voices of vulnerable populations is also critical. Participants discussed the need to develop a planetary health watch system, with an increasing emphasis on data, surveillance, and monitoring that links environmental change and human health. Case studies of successful climate change adaptation and mitigation actions that improve health and transfer resources to vulnerable people can accelerate progress towards a healthy, net zero emission future.

PANEL V: KEY PRIORITIES AND INTERNATIONAL COOPERATION FOR PLANETARY HEALTH

Dr. Seto and Weiqi Zhou, Chinese Academy of Sciences moderated the final panel focused on synergies, knowledge gaps, and key research priorities for China and U.S. science communities to collaborate on planetary health and sustainability.

Joan Rose (NAE), Michigan State University, discussed issues related to water, focusing on SDG 6 (Clean Water and Sanitation). As of June 20, 2023, there were 1,671,877 deaths attributed to dirty water and related diseases in 2023.¹⁰ Meeting drinking water, sanitation, and hygiene targets by 2030 will require an increase in the pace of progress by four.

Dr. Rose described that in the recent decade, researchers studying water quality have been focused on microbial source tracking targets, pathogens and water-borne diseases. Major global land use changes including the dramatic decrease in wetlands and increase in animal and human feces and wastewater have led to unprecedented

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water pollution, simultaneously water use (from both surface waters and ground waters) has exponentially increased. New tools, including PCR (Polymerase chain reaction) technology and genetic fecal pollution diagnostics, have allowed for enhanced global freshwater and wastewater surveillance, including identifying COVID-19 and conducting pathogen risk assessment. Dr. Rose noted that the One Water framework includes all waterways, storm waters, ground water, surface waters, drinking waters and wastewaters and the linkages between them. To bridge the One Water and One Health concepts, there is a need to utilize advanced diagnostics and global pathogen mapping tools and to focus on financing and policies that will prioritize wastewater treatment, resource recovery, management, and reuse.

Maureen Lichtveld (NAM), University of Pittsburgh, discussed issues related to building a planetary health workforce. A planetary health workforce must have the competencies, skills, and abilities to address issues at the community level, as well as health disparities, environmental threats, climate change, and the broader issues facing planetary health. Dr. Lichtveld discussed the six strategic elements for planetary health workforce development, including (1) monitoring workforce composition; (2) identifying competencies/defining curriculum; (3) designing integrated learning systems; (4) using incentives to assure competency; (5) conducting evaluation and research; and (6) assuring financial support.¹¹ To develop a planetary health workforce development, there is a need to create learning opportunities across existing disciplines and a new transdisciplinary cadre, she stated. The latter effort could be supported by creating joint degree programs, “roving” residencies, and collaborative research training grants.

Binbin Li, Duke Kunshan University, discussed the synergy between biodiversity conservation and other international agendas. Promoting biodiversity in the theme of planetary health is important, she stated. Biodiversity conservation is not highlighted among different international agendas; however, there is a need to address the synergy between areas commonly identified in international agendas, including poverty, activation, climate change, and human health. Tradeoffs do exist between these areas and should be acknowledged, she suggested.

Dr. Li noted that biodiversity loss, natural disasters, and zoonotic diseases have common drivers, including, climate change, landcover/land use change, and overexploitation. In places where extreme weather has increased due to climate change, there are 30–70 percent more landslides, which also has a significant effect on biodiversity. Dr. Li emphasized that future actions are needed to address these challenges for biodiversity conservation, including better spatial planning for multi-functions; an examination of the landscape and globe to consider spill-over effects; expanded interdisciplinary approaches to translate synergy into different languages; and cost-effective biodiversity monitoring to support decision making.

Xiaoling Zhang, City University of Hong Kong,¹² stated that social-economic systems are experiencing a constant state of flux and changes among globalization, technology, government, market, culture, and social issues. On one hand, strict emission reduction regulations may affect economic development, leading to increased poverty and social unrest. On the other hand, relaxed emission limits will inevitably increase environmental and climate risks, directly or indirectly affecting human health and socioeconomic development. Dr. Zhang discussed the sustainability science trilemma, which highlights the crossroads between environment, economics, and equity in these discussions.

Dr. Zhang described the contradiction between economic efficiency and inequality. When the government intends to achieve more equitable income distribution through redistribution, it may lead to the loss and distortion of market efficiency. To solve the problem of inequality by means of urbanization is to consider reducing the gap between the rich and the poor in the initial distribution stage. For most countries, promoting urbanization can

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help narrow the urban-rural gap and reduce inequality within countries, she stated.

Discussions Key Priorities and International Cooperation for Planetary Health

Participants discussed the need for long-term data covering various geographic regions to further the planetary health field. Other areas highlighted included the need for improved communication with the public and with policymakers about planetary health and an expanded focus on citizen science which can inform policies that will shape the design of the cities of the future. Dr. Lichtveld said that the United States and China could commit seed funding to support data integration or supporting projects related to health equity and urban sustainability issues. This would encourage collaboration and support a transdisciplinary workforce.

A PATH FORWARD1FUTURE NEEDS AND OPPORTUNITIES

In the final session of the workshop, workshop co-chairs Drs. Seto and Zhu moderated a discussion of additional opportunities for scientific collaboration between CAS and the National Academies. Dr. Seto stated that the United States and China are on parallel tracks in their development of the planetary health field, and there would be further movement in the field if the two countries strengthened their collaboration. Suggested actions by participants to advance engagement between CAS and the National Academies related to planetary health and sustainability are outlined below.

Expanding Collaboration for Planetary Health. Several participants discussed the opportunities to develop a new model of collaboration between CAS and the National Academies, using next-generation training with a systems approach, along with efforts to engage the public. There is a need to establish an international program that engages the global research community to focus on sustainability and planetary health issues, and to promote, educate, and research these issues on a regular basis. Participants also discussed that it would be useful to establish global joint centers, with a lead institution in both China and the United States, focusing on training the next generation of leaders in research and policy development; supporting research; and enhancing evidence-informed communication.

Fostering Research on Planetary Health. Several Participants discussed the need for identifying funding opportunities from both the United States and China to support international collaborative research on planetary health, including developing joint research opportunities and partnering with other countries. There is also a need to develop research programs that focus on how nature contributes to mental health in urban areas by bringing together both natural and social scientists to discuss solutions to sustainability challenges. Participants also discussed the importance of developing an initiative that engages the oil and gas industry in sustainability discussions and identifies fossil fuels alternatives to reduce environmental impacts.

Building the Planetary Health Workforce. To build the workforce, participants discussed the critical importance of funding to support a student exchange program between U.S. and Chinese universities that focuses on planetary health and sustainability. It is essential to expand joint training skills for early career scientist, including establishing working groups around planetary health.

Developing Effective Communications and Engaging the Public and Policymakers. Several participants discussed the need for diversifying platforms for sharing information, both through virtual and in-person meetings, but also utilizing social media and leveraging journals and conferences to share information about planetary health. There is a need to train scientists on science communication, particularly around issues related to sustainability, resilience, climate change, and planetary health. Participants also discussed the importance of developing convincing stories about planetary health to engage the public and policymakers, and engaging local communities in developing and implementing actionable solutions.

DISCLAIMER This Proceedings of a Workshop-in Brief was prepared by Franklin Carrero-Martinez, Jennifer Saunders, and Emi Kameyama as a factual summary of what occurred at the workshop. The planning committee’s role was limited to planning the workshop. The statements made are those of the rapporteurs or individual workshop participants and do not necessarily represent the views of all workshop participants; the planning committee; or the National Academies of Sciences, Engineering, and Medicine.

REVIEWERS To ensure that it meets institutional standards for quality and objectivity, this Proceedings of a Workshop-in Brief was reviewed in draft form by Samuel Myers, Harvard University and Xiaoling Zhang, The University of Hong Kong. The review comments and draft manuscript remain confidential to protect the integrity of the process.

U.S. PLANNING COMMITTEE Karen Seto (NAS) (Chair), Yale University; Ashok Gadgil (NAE), University of California, Berkeley, and Lawrence Berkeley National Laboratory; Jianguo “Jack” Liu, Michigan State University; Stephen Luby, Stanford University; Steward Pickett (NAS), Cary Institute of Ecosystem Studies; and Judith N. Wasserheit (NAM), University of Washington.

CHINESE PLANNING COMMITTEE Yongguan Zhu (CAS) (Chair), Chinese Academy of Sciences; Shilong Piao (CAS), Peking University; Keping Ma, University of Chinese Academy of Sciences; Weiqiang Chen, Chinese Academy of Sciences; and Yi Shi, University of Chinese Academy of Sciences.

U.S. STAFF Franklin Carrero-Martinez, senior director, Science and Technology for Sustainability (STS) Program; Emi Kameyama, program officer, STS Program; and Danielle Etheridge, administrative assistant, STS Program.

CHINESE ACADEMY OF SCIENCES STAFF Bolun Ning, Bureau of International Cooperation; Yiqi Jiang, Bureau of International Cooperation; and Xin Lu, Institute of Urban Environment.

SPONSORS This workshop was supported by the National Academies George and Cynthia Mitchell Endowment for Sustainability Science and the Chinese Academy of Sciences.

For additional information regarding the workshop, visit: www.nas.edu/sustainability.

SUGGESTED CITATION National Academies of Sciences, Engineering, and Medicine. 2023. China-U.S. Scientific Engagement: Key Issues and Possible Solutions for Sustainability and Planetary Health: Proceedings of a Workshop-in Brief. Washington, DC: The National Academies Press. https://doi.org/10.17226/27334.