13 million health professionals from 90 countries have written this week to the leaders of the world’s 20 largest economies, calling for an economic recovery from covid-19 that prioritises human and planetary health.

The #HealthyRecovery letter draws attention to the vulnerabilities of global populations prior to covid-19, both in terms of governments’ lack of pandemic preparedness but also to the social and environmental determinants of poor health—inequality, underinvestment in health systems, and ecological destruction. “We must learn from these mistakes and come back stronger, healthier and more resilient” the letter urges.

Maria Neira, Director of the Department of Public Health and Environment at the World Health Organization, who has promoted the letter said, “We need to make sure that the day we take off these masks, we will breathe clean air”

From a global health perspective, the covid-19 pandemic has come at a time when scientists and policymakers have been in a state of increasing despair. Having achieved the relatively simple task of reaching a consensus that we need to act urgently on climate breakdown, they have been unable, in a “post-truth” world, to meet the task of building a political consensus for change. The challenge is political—but where are the political leaders that will save us?

This problem is well illustrated by the identities of the 21 world leaders to whom the #HealthyRecovery letter is addressed. With a few exceptions, these custodians of the global economy are male, in their mid-60s and on the right of the political spectrum. Their political worldview has developed within the context of fossil fuel powered economic growth and social inequality. Many leaders have direct personal and political ties with the oil and gas industry.

Constrained by an outdated way of thinking, it’s hardly surprising to see little more than lip service being paid to environmental issues, for the truth is that this 20th century economics cannot provide solutions to the 21st century problem of ecological breakdown. Arguments put forward to sustain the current system simply do not hold water: we cannot have an aviation industry powered by electric aircraft. There is not enough lithium in the world to replace all cars with electric vehicles. Intensive farming methods will no longer be able to provide us with food when the topsoil has been washed from the fields.

As a paediatrician I celebrate the growth of my young patients as a sign of health and the same can be said of economic growth in a young economy. But there comes a point in adulthood when “a growth” takes on an entirely different and sinister meaning. If the 20th century was about economic growth, then the 21st must be about sustainability. Unfortunately we are two decades behind schedule, and the world’s 2.2 billion children are looking at their future down the twin barrels of climate and ecological breakdown.

In the UK, the country worst-hit by covid-19 in terms of per-capita deaths, the lockdown has provided an unlikely source of hope for social and environmental campaigners. Carbon emissions have plummeted and entire fleets of aircraft are grounded. The improvements in air quality in Europe due to the lockdown has led to 11,000 fewer deaths in April alone. 

Political changes that seemed impossible just a few weeks ago have suddenly become possible.

During the lockdown we have begun to understand where our priorities lie; in health, in food production, in housing provision, and in mutual support for one another. A healthy recovery requires a shift in the philosophical foundations of our society. Health professionals, celebrated by the public in recent weeks, are well placed to be at the forefront of this transformation.

The scale and urgency of this required change is great. The way out lies both in adopting new digital and renewable technologies, but also in abandoning unsustainable 20th century inventions such as car and aeroplane engines, herbicides, and single use plastic. We need to rediscover the knowledge of our ancestors, reconnect with our local communities, with art and music, with food production, with the soil.

History has shown us that significant change rarely comes about incrementally; the founding of the NHS, the discovery of the oral contraceptive pill and the fall of the Berlin Wall were all moments in history that have driven significant and irreversible societal change.

We are now living through a global political inflection point. Covid-19 has changed the world, but there are many more challenges on the horizon. We cannot turn back; rather we must move forwards with courage in the context of an uncertain future. With a #HealthyRecovery, another world is possible.

Alex Armitage, ST6 Paediatric Emergency Medicine, Queen Alexandra Hospital, Portsmouth.

Competing interests: None declared.