Developing Transdisciplinary Leadership to Address Planetary Health: A Competency-Based Approach

Introduction

Climate change, biodiversity loss, and pollution present pressing challenges for humanity, with far-reaching implications for human health and health care delivery systems, the well-being of communities worldwide, and life-supporting ecosystems globally (WHO, 2015; IPCC, 2022; USGCRP, 2023). Multi-sectoral solutions can address adverse impacts on planetary health (i.e., the health of human civilization and the state of the natural systems on which it depends) (Horton and Lo, 2015; Whitmee et al., 2015). To implement these solutions, leadership is needed from health professionals, including physicians, advanced practice providers, nurses, pharmacists, and allied health professionals; hospital and health system management; public health professionals; health policy experts; health professional societies; industry leaders; government; and beyond (Watts et al., 2021). Planetary health can be conceptualized as an ecological and collective challenge with important policy dimensions, requiring emerging leaders to act within and beyond the health care sector, integrating health perspectives into climate and environmental policies while driving interdisciplinary collaboration (Watts et al., 2021; Cerceo and Vasan, 2023; Salas, 2020). Because leadership in this area is not confined to health care systems, effective solutions to complex problems would cross boundaries and siloes, extending to local and federal government and private industry, as well as health professional societies, schools, and agencies.

Planetary health leadership requires acquiring new knowledge not traditionally taught in standard health professional curricula. This calls for leaders with wide interests and diverse expertise (YEC Women, 2017). In this commentary, an expert‑authored, proposed framework of skills and competencies from a variety of professional backgrounds is presented to equip planetary health leaders to tackle transdisciplinary challenges. While distinct competencies are outlined for each background, the goal of all planetary health leaders should be to pursue additional skills and competencies from related disciplines to enable decisive action and bridge transdisciplinary boundaries (Watts et al., 2021; Salas, 2020; Huikko-Tarvainen, 2021). Each of the following sections provides an outline of skills and competencies needed for various types of health leaders (see Table 1), each of whom might have multiple competencies to address their diverse roles.

This framework of skills and competencies is proposed by the authors as a starting point for discussion. It does not represent a validated, consensus-based, or National Academy of Medicine (NAM)–endorsed standard. Further validation, refinement, and adaptation of the framework would be useful.

Leaders in Hospital and Health Systems Sustainability

Hospitals and health systems, as significant contributors to the health care sector’s environmental footprint, would benefit from planetary health leadership to enable actions to reduce their environmental health impact while building climate-resilient health care systems (Lenzen et al., 2020). Clinical and administrative leaders in this space can implement energy-efficient technologies, transition to renewable energy sources, and adopt sustainable procurement practices among other interventions. These actions not only reduce greenhouse gas emissions but also generate operational efficiencies and cost savings. Examples include clinician-led decarbonization efforts at the University of Pittsburgh health system, Boston Medical Center Health System’s clean energy prescription program, and system-level progress in the UK National Health Service (NHS) and the European Union (University of Pittsburgh, 2024; Dillon, 2023; van Hove and Leng, 2019; Schmidt et al., 2025). Despite these successes, sustainability remains underprioritized in most health systems.

Planetary health leaders in this space should not be limited to the C-suite or to physicians (MacPherson and Hill, 2017). Equally important is fostering a culture of sustainability among other health care professionals and staff, while aligning efforts with the communities that health care systems serve. Leaders across nursing, environmental services, engineering, pharmacy, food services, and procurement are essential to operationalizing sustainability, strengthening collaboration, and advancing climate-smart health care through informed decision making on infrastructure, supply chains, and clinical practices (Cerceo and Franzblau, 2021). For instance, they need to understand how to make effective business arguments, weigh return-on-investment strategies, and have sufficient knowledge on architecture and engineering to support system resilience and climate-smart health care transformation such as preferred anesthetic gases, air exchange standards, device reprocessing, and supply chain optimization (see Table 1, Competency Domains 1–4).

Leaders in Clinical Care

The authors agree that planetary health leaders must develop and implement climate-aware clinical care practices and clinical protocols for diagnosing, treating, and managing conditions directly linked to climate exposures. Examples include establishing standardized approaches for managing heat-related illnesses, respiratory conditions exacerbated by wildfire smoke and air pollution, vector-borne diseases, mental health impacts, and climate disasters. These protocols could address the needs of vulnerable populations—including children, older adults, pregnant individuals, outdoor workers, and those with preexisting conditions—and develop standards for avoiding low-value care, including overtesting, overdiagnosis, and overtreatment (Ali et al., 2024).

Planetary health leaders also play a crucial role in building resilience within health care systems to withstand climate-related disruptions. This involves participating in climate vulnerability assessments, developing comprehensive emergency preparedness plans for extreme weather events, and ensuring continuity of care during climate crises. Leaders can also champion infrastructure investments that enhance resilience, such as backup power systems, flood protection plans, and heat-resistant building designs (Cerceo and Singh, 2024; see Table 1, Competency Domains 1, 2, 5).

Leaders in Public and Population Health

Public and population health leaders operate at the intersection of health equity and climate resilience, building technical capacity for health impact surveillance, developing early warning systems for climate threats, and performing vulnerability assessments for at-risk communities. These leaders can implement community-protective interventions before, during, and after climate events, while also diagnosing and investigating health problems related to climate change. Their expertise is crucial for communicating the health and economic benefits of climate solutions, evaluating climate-related health impacts at scale, and reducing disparities worsened by climate change (Sorensen and Fried, 2024).

Additionally, public health leaders can foster transdisciplinary collaboration across sectors to ensure a collective vision and action. They can strengthen pathways that rapidly translate scientific knowledge into meaningful health policy, while engaging vulnerable and marginalized communities to understand their lived experiences of climate change. During climate-related events, these leaders mobilize community partnerships to identify and solve health problems, particularly among vulnerable populations.

Leaders can use evidence-based, culturally responsive communication to translate climate health risks into clear, actionable messages, particularly for communities disproportionately affected by climate change. Transparent, consistent, and data-driven campaigns delivered through trusted messengers can overcome information barriers, promote preventive behaviors, and strengthen community engagement, as demonstrated by initiatives such as New York City’s “Be A Buddy” program (New York City Mayor’s Office of Climate & Environmental Justice, 2019; Myers et al., 2015; see Table 1, Competency Domains 1, 2, 5, 6).

Leaders in Health Policy

Health policy leaders’ influence extends beyond traditional health care boundaries and shapes the fundamental system governing public health, health care delivery, and environmental protection. The authors believe these leaders need to understand how regulatory frameworks and governance structures are related to environmental health. By applying evidence-based approaches that quantify both the health and economic impacts of climate-related threats, policy leaders can design comprehensive policies that simultaneously address immediate health needs while building long-term climate resilience. The skills required to achieve this goal include navigating complex political landscapes, building coalitions across ideological divides, and creating governance structures that institutionalize planetary health considerations across all health-related decision making processes (see Table 1, Competency Domains 1, 2, 6).

Local, State, and Federal Government: Scaling Solutions

Health policy leaders are pivotal in advancing planetary health through their multilevel influence across local, state, and federal governance structures. At the local level, these leaders can drive immediate impact by implementing city and county ordinances that protect vulnerable communities from climate hazards, establishing local sustainability standards for health care facilities, and creating community-based early warning systems for climate-related health threats. Simultaneously, at the state level, they can navigate complex regulatory frameworks to develop comprehensive climate health action plans, secure dedicated funding for public health adaptation measures, and foster regional coordination among health care systems facing similar climate vulnerabilities. Policy-focused planetary health leaders can inform and support the work of local, state, and federal governments as consultants, advisors, or subject matter experts. By emphasizing health benefits, these leaders can strengthen support for green infrastructure, renewable energy, and community-based climate adaptation initiatives.

Sustaining Climate Health Leadership

The authors agree that planetary and climate health leaders must strategically adapt to sustain and advance progress by leveraging local and state governance structures. Simultaneously, they can continue to educate policymakers and the public about the health consequences of environmental policy decisions, connecting climate threats like air pollution, extreme heat, and natural disasters to tangible health outcomes. Partnerships with accreditation bodies can support progress by helping establish standards. Evidence-based messaging can be framed around universal values such as economic security, family health, and community well-being. Furthermore, by embedding planetary health principles into institutional governance, health care operations, and accreditation standards, leaders can create durable, system-level change. The collective power of organized, cross-sector coalitions, including clinicians, scientists, public health officials, and public supporters, could potentially maintain and even accelerate the implementation of environmental and health protections.

Industry Leaders

Industry leaders can leverage their market influence, technical expertise, and supply chain control to catalyze health care actions. They can also strategically redirect capital investment toward developing clean energy technologies and circular-economy innovations, reducing waste in manufacturing processes, supporting sustainable health care supply chains, and improving operational resilience of the health sector. Furthermore, they can collaborate with suppliers and health care systems to implement comprehensive roadmaps to reduce emissions. Suppliers with strong Corporate Social Responsibility goals may work to decarbonize production or provide repurposing options for medical instruments. For instance, the NHS net-zero supply chain initiative aims to catalyze industry-wide innovations in sustainable medical products, carbon-neutral manufacturing, and responsible material sourcing (NHS Supply Chain, n.d.).

Industry leaders can develop collaborative partnerships with health care providers to create solutions that benefit both the environment and the economy. Examples include partnerships to develop biodegradable medical supplies or efficient waste management systems (see Table 1, Competency Domains 1, 2, 7).

Health Professional Education and Society Leaders

Medical societies could be vital in advancing planetary health by shaping professional norms, supporting education, and endorsing systemic change. They can raise awareness of the health impacts of climate change, promote climate-smart clinical practices, and integrate planetary health into continuing medical education and professional development. Their policy statements, position papers, and educational activities can influence public policy on clean energy, environmental justice, and health system sustainability (Bush et al., 2022; American College of Physicians, 2025; Crowley et al., 2022). They can develop planetary health-focused educational resources for health care professionals, amplify messaging, and disseminate best practices and research. The Medical Society Consortium on Climate and Health aligns the interests of approximately 60 medical societies, while other groups, such as the NAM, have created initiatives to help achieve a climate-resilient and sustainable health sector (The Medical Society Consortium on Climate and Health, n.d.; NAM, n.d.). Several organizations, such as the American Medical Association and the American College of Physicians, have passed resolutions and promoted climate health content in their conferences (American Medical Association, 2022; Crowley, 2016). The Planetary Health Alliance and the World Health Organization help build consensus across national boundaries, accelerating the integration of planetary health principles into clinical practice, research, and education (Planetary Health Alliance, n.d.; WHO, 2024; see Table 1, Competency Domains 1, 2, 8).

Competencies for Health Professional Educational Leaders

Leaders in medical education have the responsibility to embed planetary health principles into the training of future health care professionals, placing broad public health concerns on par with biochemical pathways (Matsas et al., 2022; Cerceo et al., 2022; Mian and Khan, 2020). Medical education leaders can prioritize developing future planetary health champions to sustain progress (Rabin et al., 2020; Saltzman, 2019; NHS Leadership Academy, 2011). Leadership training could integrate climate and health principles with systems thinking and interdisciplinary collaboration at an early stage, recognizing that physicians’ roles go beyond healing individual patients to preventing disease in those patients they may never see (Watts et al., 2021).

Specific leadership training based on a competency framework, such as the NHS Clinical Leadership Competency framework, can be integrated into different levels of medical training (NHS Leadership Academy, 2011). The Global Consortium on Climate and Health Education has developed a comprehensive framework of core competencies to prepare health professionals to respond effectively to the climate crisis, organized into five domains: Knowledge and Analytic Skills, Collaboration and Communication, Policy, Public Health Practice, and Clinical Practice (Sorensen et al., 2023; McLean et al., 2022).

Planetary health can be integrated into existing courses, such as public health, epidemiology, or health systems management, along with organ system-based modules (Rajagopalan and Landrigan, 2021; Sorensen and Garcia-Trabanino, 2019). Case studies on disaster preparedness can include discussions on how climate change exacerbates natural disasters and impacts vulnerable populations. Sustainable health care practices can be integrated as quality improvement activities for medical trainees that align with Accreditation Council of Graduate Medical Education Clinical Learning Environment Review Pathways (Tuck et al., 2024; Kalwaney and Cerceo, 2024). Leaders of boards and other standardized medical exams can include climate and environmental issues in their examination blueprints regardless of specialty.

Mentorship and networking opportunities are also important for nurturing emerging leaders and can include trainees working on sustainability initiatives, engaging in climate activism, or collaborating with community organizations to address environmental health disparities. Meetings of health professional societies and organizations are an excellent venue for networking and mentoring (Medical Students for a Sustainable Future, n.d.; Childs, 2020; Practice Greenhealth, 2025). The University of Colorado’s Diploma in Climate Medicine trains clinicians to champion climate-resilient policies, credibly address environmental justice issues, and lead health care systems in decarbonization and resiliency (University of Colorado Anschutz School of Medicine Climate and Health Program, n.d.).

Educators also play a role in calling for institutional change within academic organizations. They can lead efforts to reduce the carbon footprint of medical schools and other health professional schools, promote sustainable practices on campuses, and call for integrating planetary health into accreditation standards. By aligning their clinical sites with the principles they teach, educators demonstrate that planetary health is not just an academic subject but a lived commitment (see Table 1, Competency Domains 1, 2, 9).

Summary

Planetary health leadership encompasses a wide array of roles across health systems, public agencies, government/policymakers, industry, medical societies, and medical education. Each sector contributes unique strengths, expertise, and perspectives to the collective effort of addressing the climate crisis. The goal is not to mold a single archetype of a leader but to embrace and cultivate a diversity of talents, experiences, and backgrounds across the various disciplines involved, reflecting the complexity of current challenges. A transdisciplinary approach to planetary health would require meaningful collaboration among people from diverse disciplines, the integration of health considerations into climate policy, and investment in the education and development of future leaders who are knowledgeable about other disciplines and can work with them. Concerted efforts would strengthen the capacity to build a sustainable and resilient health care system in the face of a rapidly changing planet.

Table 1 | Proposed Competencies in Planetary Health

SOURCE: Created by the authors.

NOTE: [a] This framework of skills and competencies is proposed by the authors as a starting point for discussion. It does not represent a validated, consensus-based, or NAM–endorsed standard. Further validation, refinement, and adaptation of the framework would be useful.