Planetary Health and ONE Paleopathology: Climate Adaptation, Risk, and Resilience in the Holocene

Climate change poses significant challenges to human health and security through both direct impacts from extreme weather events and indirect effects mediated through changing ecosystems. This paper introduces ONE Paleopathology (OPP) as a deep-time perspective within the Planetary Health (PH) framework, examining how past human-environment interactions inform our understanding of present and future health challenges. Through case studies of malaria and historical syndemics, we demonstrate how OPP contributes to understanding the complex relationships between environmental change, social inequality, and human health. We first examine how climate change is altering malaria transmission patterns globally, while highlighting the value of Indigenous and Local Knowledge (ILK) systems in disease management. We then analyze two historical syndemic case studies: the pellagra epidemic in nineteenth-century Italy and the 1918 influenza pandemic at the Mississippi State Asylum. These examples illustrate how environmental changes, socioeconomic inequality, and institutional practices intersect to create health disparities, particularly among marginalized populations. The Italian case reveals how mono-cropping and capitalism contributed to a syndemic of malnutrition, mental illness, and tuberculosis, while the Mississippi case demonstrates how racial segregation and institutionalization exacerbated pandemic outcomes. These historical perspectives provide crucial insights for addressing contemporary health challenges in the context of climate change. We argue that incorporating OPP into PH frameworks enables better understanding of long-term human adaptations to environmental change and more effective, equitable responses to current health crises.