Towards planetary health systems: a manifesto for a revised quadruple aim for healthcare improvement

Abstract Non-technical summary Healthcare systems significantly impact the environment, which in turn affects human health. To address this, we propose to revise a popular framework for healthcare improvement, by introducing the advancement of planetary health (the health of both humans and the natural systems) among the aims that health systems should pursue. This approach suggests reducing medical service needs through disease prevention, minimizing environmental impacts, and supporting global efforts to protect planetary health. Practical applications to bring about these pathways are documented in the literature. Technical summary Restoring the health of the planet, with concurrent benefits for human civilization, is paramount. Healthcare systems play a crucial role in this regard, considering the environmental impact of health services. Widely recognized approaches to designing healthcare systems for the optimization of their performance are based on the pursuit of multiple aims, such as the Triple Aim and Quadruple Aim frameworks. The objective of this work is to revise the latter by substituting ‘Advance Planetary Health’ for ‘Improve Population Health’. The objective of advancing planetary health supports all other pre-existing objectives: lowering costs, enhancing patient experience, team wellbeing, and population health, which directly relates to planetary health. Health systems promoting planetary health reduce the need for medical services through disease prevention and health promotion, pursue the provision of appropriate care, minimize the overall environmental impact of medical services, and support planetary health initiatives across all sectors and society. Multiple interconnected pathways exist to operationalize the above components. A revised quadruple aim for healthcare improvement, aligned with social and economic goals of sustainable prosperity and wellbeing, may be a desirable step toward constructing planetary health systems capable of maximizing the health of humans and natural systems. Social media summary It's time for new ‘planetary health systems’: focusing on planetary health to enhance healthcare performance. #PlanetaryHealth #ClimateCrisis #HealthcareImprovement.