Frederik: Welcome to the Sustainable Healthcare Podcast. In today’s episode, I have Mia Heide in the studio with me, and she has just released a very interesting working paper on the planetary boundaries and health. So in particular, the consequences for exceeding seven out of nine planetary boundaries and which impacts that has on health and wellbeing. So I’m really excited to have Mia in the studio. She is super knowledgeable and I warmly recommend reading the paper to anyone who hasn’t already read it. So without further ado, Mia, welcome to the show.

Mia: Thank you so much. I’m really happy to be here.

Frederik: I’m really excited to have you here. Thank you so much for coming in. If the most recent episode we recorded, I had this opening question that I think just really sets the scene nicely. So can we start off with me asking you, who are you and what do you like to do when you’re not producing working papers?

Mia: Yeah, I really love that question. As you said, my name is Mia and I am, I’m actually an engineer today. I work in WELA (Wellbeing Economy Lab), which is a think tank. But about me, I’m a mom, which takes up most of my time. I have a son who is 15 months old, and we actually already have the next one coming in five months from now. I am pregnant. So right now I’m very pregnant. I’m very much a mom, so that takes up most of my time to be honest.

Frederik: Neat. So we are looking at T minus five months and 15 months. So we’re in the just took the first couple of steps, still a lot of type stage.

Mia: A lot of divers. Yeah. But he has been walking for three months, so he is all over the place. Yeah. And it’s a bit rough that I’m not allowed to carry him because I’m pregnant and that’s a bit hard. But otherwise he’s thriving and well, and I’m in pure love with it. It is, but it’s also the hardest thing to do in the world. Everyone who says it’s not hard to be a parent is definitely lying.

Frederik: Yeah. It’s no joke. What’s your favorite thing about being a mom?

Mia: Oh, my favorite. When he started being able to give hugs, when they get to that age where they actually give something back. When he gave my his first hug and he put his arm around me and put his head on my shoulder, I was like, ah, this feeling. That’s why.

Frederik: Yeah. That’s what makes the work worth it.

Mia: Yeah. Then you can really feel the love.

Frederik: My son gave me his first step on my birthday at nine o’clock in the evening, and it was one of those moments that just really stands out to me. Yeah. Who even knows if it was his first step, but it was the first step that I saw. Or anyone kind enough to fool me into thinking it was also the first step they saw. Thanks a lot for sharing that, and congratulations on another one coming up. So really excited to hear about that.

Frederik: You’ve just released a working paper. Can you tell our listeners a bit more about it so I don’t butcher the titles and the contents too much, and then later on who should read it if they haven’t already read it or heard about it?

Mia: Yes. So the working paper is divided in two parts. So the first part is really about how do we scale the planetary boundaries to specific countries. In this context it is for Denmark. So which sharing principles should we use in order to downscale so we can see how much a specific country is allowed to emit. And there are different sharing principles and there’s a lot of research in this. I also did a PhD in this area. But it’s a lot of ethical questions really. And I also work a lot with human needs in my PhD. So it’s also balancing and calculating: is it even possible to fulfill the basic needs of all within the planetary boundary. So we are not even considering like our lifestyle, it’s just the bare minimum in order to have a sufficient lifestyle. Is it even possible?

Frederik: How is the sufficient lifestyle defined?

Mia: Yeah, so there are different ways, but there’s one specific study by Melbourne Hopkins and it’s from 2020 where they, and it’s very Western perspective. So of course this could look very different, but they do a bottom up model where they really say like, how much water is needed for hygiene, how much is needed for drinking, how much in terms of calories, proteins and so on, considering food, what’s the bare minimum of living space and house, et cetera. And you can question this because it’s also been criticized a bit for this Western perspective, but they’re called decent living standard, and they’re one of the ones that are furthest in the study about this. And my PhD took a different perspective. I did a top down model where you can say: this is bottom up where you build from the bottom, but you tend to overlook all the commons, all the things that get our society put together. For example, some of the healthcare services. So when you do a bottom up, it’s very difficult to place healthcare. How much do you need of that? Whereas if you look at a top down model, we, in my PhD, we identified the most sustainable countries. There are no absolute sustainable countries, but we identified the most sustainable ones. And then we looked: how is their lifestyle? How are they spending their money? How much is going to healthcare, how much is going to education, and so on. And then we did this sharing principle based on that. So there are different ways of considering these basic human needs. And when we said the most sustainable countries, I maybe should elaborate just a little bit that it means countries that are doing quite well in terms of social performance. They have a high human development index. People have good lives, and they are closest to staying within the planetary boundaries. That was how we defined these most sustainable countries.

Frederik: Can you name a handful of those?

Mia: Yes. It could be Sri Lanka, it could be Costa Rica. It could be. There were actually around six were identified in, and then they were very different. Some of the countries were quite big, some were small, some were islands, some were middle of continents. There was only Albania from Europe that got, that performed quite well. But yeah, so that’s some of them. Jordan, yeah. So it was quite interesting study to do actually. Yes, but that’s, of course, it’s a bit far from this working paper that I just did. But the whole point is that you can downscale the planetary boundaries with different principles. And what we specifically looked at in this working paper was equal per capita. This means everybody gets exactly the same share. It’s quite easy to do the calculation, but you have to remember that equal is not the same as fair. And that means that even though you and I get exactly the same share, a poor kid in Africa would get exactly the same. And is that then fair? Because if you consider our historical emissions or our wealth, we could use other sharing principles. So that could be capacity to reduce and that’s based on how wealthy is a country. This will give Denmark a very small share. It would actually give us a negative share.

Frederik: That means we have, because we have more capability to actually reduce compared to someone living with a lower standard of living, with fewer choices available to them.

Mia: Yeah. Yeah. There are many perspectives. So first of all, you could say it’s aligned with that. We have already had all those emissions because and we earned a lot of money based on those. And that means it’s, we don’t have to develop more infrastructure, for example, we don’t have to build new hospitals. We don’t have to build new schools because we already got that compared to other countries that has to do that in the future. So we already have emitted some and then we earn money based on that, so then we can pay. And pay means other countries so that they can and pay is also in terms of money, but also in terms of emissions. So they are allowed to emit more in order to get this type of infrastructure and schools and hospitals, et cetera. So there are many perspectives but it’s more like a fair principle based on wealth. There’s also historical emissions or and that’s based not on the wealth you earned, but it’s more related to your historical emissions. So it’s like you could say as a burden, so that you would take the responsibility for the burden that you already put on other people, but also on the planet. And in that sense, Denmark is, has had really high emissions historically. And when we have to pay back those emissions, we we also get a negative share, even more negative than the capacity to reduce. So if we would go for that principle, we would have a very negative share in Denmark.

Frederik: If we’re zooming out a little bit and we’re looking at what is sustainability and personally, I like to go by the Brundtland definition where you say it’s the capacity to live your life without compromising the capacity of future generations to live their lives, paraphrased a bit. So if we’re looking at it from that perspective, what you’re saying is that the generations that came before us compromised future generations’ capacity to live their lives. So our lives without compromising the capacity for future generations again. So in a way what you’re suggesting is that if we have a longer timeline and a longer accountability, and not just on an individual level, but on an ancestral level, the budget would be well overspent.

Mia: For wealthy countries. For wealthy countries like Denmark, it is, yeah. So this historical debt, if you use that principle, wealthy countries like Denmark would get a negative share. But then the issue is that when you consider the Brundtland definition, it’s you are supposed to be able to fulfill your needs. Everybody is supposed to be able to fulfill their needs despite historical emissions, despite material wealth. But because you had food yesterday does not mean you have food tomorrow. And it’s not possible to produce food for a negative CO2 emission today. So there’s some issues if you say that Denmark’s share tomorrow should be negative because then it’s not possible to fulfill the basic needs in Denmark. You could say that Denmark should have a smaller share because we don’t have to build, as I said before, the infrastructure, hospitals, schools, et cetera. Whereas if you go to Kenya or Uganda, they have to do that, right? But you cannot, it’s difficult with this definition that you should be able to fulfill your basic needs because you can’t with a negative share. But it’s probably fair that we get a negative share, but it’s then it’s a bit of a paradox. I hope you can follow me on this, because it’s not possible to fulfill basic needs for a negative share. And then there’s a last one, last principle that I’d like to introduce which is called grandfathering. And grandfathering in this case means grandfathering emissions. So that means it’s very unfair and it actually does not exist in the ethical literature research. It means that if you already have a big amount of emissions, you can continue having the biggest amount. So it’s very unfair. It was appealing most to companies apparently. So if you are a large company with, let’s just say something high in the, let’s just imagine that we have one very big company and they have 1% of the global emissions, and then with the grandfathering, they can continue having 1%. Even though we say the total budget for the whole planet is decreasing, it’s getting smaller. They would still get 1% of that, so they would have to decrease, but proportionately, they would still get 1%, which is totally unfair. But that’s the grandfathering principle, and that means the countries with the largest emissions can continue having the largest emissions. So completely unfair. But that’s the principle. And you could say, if you are very innovative and working with startup new technologies, you will get no share because historically you had no emissions. So there’s some flaws in this. So it gets very tricky if you match, you develop a new healthcare technology. Then you would get absolutely no share because historically you had no emissions. So with this principle, there are some issues, especially relating to new technologies. Yeah. So these are the different principles and typically we end up with the equal per capita because it’s rather easy to calculate, rather easy to explain. But there are some issues with this, that equal is not the same as fair.

Frederik: I think that was a very clear explanation of something that is extremely complex. Thank you.

Frederik: Can you walk us through what is WELA and how did it start?

Mia: Yes. So I’ve been on this journey not for that long. I started in February this year and we are now in November. It’s also 2025. Case anyone’s listening a hundred years from now. But WELA is very new. We are a think tank and WELA started almost two years ago. So we had, we actually had one year anniversary in February when I started. So it’s a very new organization and WELA is short for Wellbeing Economy Lab and we are a science based or research based think tank so we are doing analysis, mainly focusing on the Danish Parliament. So we would really like to influence the politics and especially our focus is on implementing wellbeing economy. And the thing about wellbeing economies, maybe it’s getting more known in general, but it can also still be misinterpreted a bit. And the whole point about wellbeing economy is that we put wellbeing in front of the economy. And maybe this sounds a bit radical, but it’s not the case in our society today. The economy has to work well for the economy’s sake. We need to have GDP growth. And this is of course, something that we question quite a lot, that maybe we don’t need GDP growth. Maybe we need to have wellbeing first, and then we need to design an economy that supports the wellbeing of people. And then it doesn’t matter whether the GDP goes up or down and probably it’s gonna go down or it’s gonna be stable. But we are putting wellbeing in front of the economy and then trying to influence the political parties in order to implement new methods that are taking this into consideration. And the very short definition, besides putting wellbeing in front of the economy is that wellbeing economy is making sure that we can all live good lives and have wellbeing within the planetary boundaries now and in the future. So we are working a lot with future generations.

Frederik: You’re sure you’re not a communist.

Mia: Yes. And it’s now and in the future. So we are working a lot with future generations. As you just mentioned, we are really not like a West Wing activist organization. We are really a science-based think tank, and we are not targeting specific political parties. We are actually trying to be mostly at the middle. But it’s very important for us that it’s science based and we are doing our best to also be, how can you describe it? Not communistic. So we’re working a lot with freedom and how this will actually, if you manage to have wellbeing for all within the planetary boundaries, you would actually gain more freedom as an individual. And this is of course one of the things that we will be challenged a lot on by the mainstream economist because the current economies build a lot on preferences and you can choose whatever you like. And when we have a very different story about the good life it’s,

Frederik: There there’s a few things that then the anthropologist in me hears. It seems to be a founding principle. Humanism, universal humanism is one of the ethical principles that you’re putting forward. And then on top of that, a subscription to rationality as a concept and thereby abiding by whichever observations and premises we can define through the natural sciences. Supposing that’s those are the aesthetics that are put forward by WELA, right?

Mia: Yeah, you could say it like that. And then of course, it’s very interdisciplinary. I’m the only engineer here. And you mentioned the anthropologist view. So of course we have sociologists, we have people who studied economics. We have a broad political science. We have a broad range of different backgrounds and that’s what’s needed in order to get to this point where we can actually implement a wellbeing economy. So there’s so much in how do you define wellbeing, health? How do you define planetary boundaries and everything in between those, and how do you impact politicians? And it’s a very exciting working environment, I would say.

Frederik: It sounds super exciting and I think one thing that really inspired me by reading the paper was this very explicit wake up call when phrasing the work around the planetary boundaries. They were recently reassessed in September 2025. We’re now in November 2025 and we have transgressed seven out of nine boundaries, which in plain language means we’re in a really bad position. And I think one of the things your paper really does well is to say this is not about goal setting or having ambitions or nice to haves, these are boundaries, meaning that there’s nothing more to spend. It’s you’ve exceeded your spending limit, and there’s no more money to spend in this sort of metaphorical bank account. So I think it would be really great if you can give us a brief intro to what are the planetary boundaries and why they’re important. And maybe you can pinpoint three of them and walk us through what is this specific boundary and what are the impacts on human health after we’ve exceeded this boundary.

Mia: Yes, let’s do that. So let’s start with the framework, the planetary boundaries. So it goes back to 2009, so it’s still quite new, I would say, but it’s great. It’s gained a broad interest globally. And I think mainly it’s because of the easy way to communicate this. And it is a brilliant perspective or framework by the Stockholm Resilience Center. And they identify nine planetary boundaries which are needed in order to keep our earth system at balance where people can thrive. In other words, it’s what’s needed in order to keep the planet in the Holocene. And the Holocene has been here almost 12,000 years, and in very short described, it means that this is when agriculture started around 12,000 years ago. Because we could predict, we had the seasons, we could predict predictive weather, and that just made it possible for us to feed more people. Basically. This was what allowed us to be this amount of people we are today. So that’s the whole starting point. So it’s about earth systems and we have these nine and when they started, they only put numbers on a few of them and then they continued. So every, not every year, but along the way they put numbers on several more of them. And as they did that, we could see more and more also got exceeded. So now we are at the state where we have seven out of nine, as you said, which are transgressed, and we of course, in a really bad state today. So let’s just name drop them. First we have climate change, it’s probably also the most known. Then we have biosphere integrity, this means biodiversity loss of biodiversity. Then we have land system change. This is mainly related to cutting down the forest. It’s also change of the land system, but it’s mainly related to the forest. Then we have freshwater change. And I think this explains itself. Then we have biochemical flows. This is emission of nitrogen and phosphorous, mainly. Something the agriculture sector is doing. So putting out nitrogen and phosphorous on the fields in order to grow crops. Then we have ocean acidification, and this one is the newest one that’s exceeded and we can translate it directly into coral reef’s death. But it is, it’s correlated with climate change and CO2 emissions. So therefore it’s no surprise that this one is exceeded now as well. We have actually known that for more than 10 years in research. But now it was just recently in the news that now we have exceeded ocean acidification that boundary as well. But it was no surprise to me. We knew we would lose the coral reefs. Especially we’ve been on that path for so long.

Frederik: That path for so long.

Mia: Yes, especially if you have read the IPCC report, you knew that at 1.2 degrees it would be 99% or something like that. Sure that we would lose the coral reefs. So it was no surprise. Then we have ozone depletion, which was, which is a good story because this was the one that we managed to fix. It was before I was born but it’s the depletion of our ozone layer, which is limiting the UV radiation. We managed to take care of this, which is really nice, that we have one good story. Then we have atmospheric aerosol loading, which is mainly related to emission of particles and the smoke. And then the last one is novel entities, can also translate it into artificial chemicals or microplastics, plastics and so on. And this was also recently updated with numbers and it is actually the one that’s exceeded the most. So these are the nine in the framework. And then your next question was if maybe we should

Frederik: Yeah I’m thinking when we are looking at those, so we now have established that there are nine planetary boundaries, and that seven out of nine of them. We have transgressed them. One of them, the ozone depletion, we’ve actually managed to reverse that one. So I think that’s actually a really important story to keep in mind that in the very short timeframe, global leaders managed to curb this one. So it’s not impossible to imagine that similar actions could be taken. And we need to be very insistent on that perspective that change is possible. A different world is possible, a different view on nature and natural capacity is possible. And that kind of brings me back to that famous Margaret Mead quote that was also quoted in our most recent episode with Fiona [?] from the Sustainable Healthcare Coalition, saying that never doubt that a small group of thoughtful committed individuals can change the world. In fact, it’s the only thing that ever has. And I do think that quote resonates so strongly with the type of problem that we have here, that we really need to insist that doing things differently is in fact possible. So if we’re looking at you, you take your pick at each of the boundaries, you know them much better than I do. And can you walk us through what are the health consequences from exceeding these boundaries.

Mia: Yes, I’d love to do that. But before I do it, maybe I would just briefly say because I know the audience in this and the listeners for this podcast is within the healthcare sector, and I would just briefly say that the starting point for this working paper was my perspective is like yours, like that we would like to decarbonize the healthcare sector. So that means we are decarbonizing every product or every service. So the perspective is that every time we manufacture something that we need in order for maintaining people’s health or curing people or whatever it could be, we will have an impact on the planetary boundary. You cannot imagine manufacturing a product without it having CO2 emissions, for example. We can reduce those, but it will have an emission. So there’s this, when you fulfill the needs of people, you will impact the planetary boundary. Planetary boundaries, but it’s also the other way around. So now we have exceeded the planetary boundaries and that will also have an impact on people. And that’s what I deep dive into in this paper. And that’s what I would like to now give some example of. It’s just to give a perspective. So it goes both ways. When we fulfill the needs of people, we impact the planet. But when the planet has been over impacted as it is today, that the planetary boundaries are exceeded. Then it limits the way that we can fulfill the needs of people, but also it has huge impact on our health. For example, it could be if we look at climate change, the most known one, right? So when we have climate change we will have more frequent extreme weather events. It could be heat waves that leads to heat stress, and in the end people might die from this. It could be local flooding. People might end up drowning, physically drowning or getting tossed because of the water masses. It could also lead to major or minor injuries. It could result in facilities in these extreme weather events. But it could also be minor things, as with increasing heat it could spread more disease, it will put more pressure on local food production. Some of these weather events can put damage and infrastructure and housing. It might reduce mobility for people and in general just impact the safety of people. So there’s so many issues related to just climate change as one example. And of course it gets worse the more the boundary is transgressed. So first we just see minor events of extreme weather events, and then later on people might be forced to become refugees. They’re forced to migrate. Maybe it’s not even possible to grow sufficient amount of food for the entire planet for the entire population on the planet. So there definitely are some, there are many issues relating to human wellbeing and health directly and indirectly by climate change. So this is just like one of them. It’s just one example. Another one that I really would like to highlight is freshwater change and freshwater is of course, it’s obvious that water scarcity would limit the access to clean drinking water for people. And of course, this will impact human health, but there’s also the issue with sanitation and increased risk of disease due to poor water quality. And this can be combined with some of the other planetary boundaries. For example, biochemical flows or this novel entity, so more chemicals going into the freshwater pools. But as the pools are getting smaller or shrinking the quality of the water will be even poorer. And this might lead to local tensions because of scarce water resources. And in the end, this can destroy ecosystems. It can improve, it can end up with threatening food security. It can end up in conflicts between different groups of people fighting for the water, and it could potentially end in mass displacement, that people has to flee because there are no water available. So there’s massive amount, and I’m just highlighting a few things here, right? It could be even more. And now I’m sitting in Denmark, it’s water is not a problem, but we already see this around the world. So it’s really present for many people. Maybe not all of these issues, but some of them, and it’ll only get worse. And then I would really like to highlight this novel entities, which is quite new because I think it was January, almost two years ago that they managed to put numbers on it. So it’s still quite new in that sense that we even managed to put numbers on it, but also that it was so exceeded when we had numbers for the first time.

Frederik: So I believe it was this, it was the team of scientists that was led by Catherine Richardson, residing in Denmark and there for a bit of a voice in the Danish ecosystem that led that assessment with the Stockholm Resilience Center in 2023, right?

Mia: Yeah, it was September 2023. They did that. I’m a bit in doubt whether this one was before, because I think they did the water. There were several updates that year. So it’s so we, because we both have the division between the green and blue water that year, and also the novel entities coming along. So there were two updates within that year. Yeah. But the one that Catherine Richardson did is also the one, the version of the planetary boundary. That’s definitely got the furthest out in the world. So they’re extremely popular, the planetary boundaries. But I just really like to put a few words on novel entities because since I’m a mom, I think, and I have several friends that we all know people who cannot get children, it’s a very present problem. And I think the link between novel entities and how exceeded that boundary is and the fertility issue is under the radar. And I hate that it’s not publicly known. So there’s so many direct health effects including higher cancer risk. And we also know one out of three get cancer today, which is crazy. And then we have this reduced fertility and we have hormone disruption and we need to maybe it’s so these novel entities, it is PFAS. It’s a huge issue in Denmark and many other places. I’m sure it’s microplastics and other synthetic chemicals and the very scary thing about this is there’s so many unknown health effects. Like we simply don’t know. There are so many chemicals we don’t know the effect on human health. And for me that’s very scary because we cannot explain why people get cancer. We cannot explain these fertility issues, but we know there’s a link for these novel entities. So for me, it’s just very important to highlight that these are some of the most present health issues that people are not responsible for themselves. So I know that we have obesity and there’s many different reasons for that. It’s also a huge problem, stress, depression, huge issue, especially in the Western world. But these who gets cancer, who cannot get children, it’s a lottery. It’s a complete lottery. And I think a lot of that is related to this novel entity being transgressed. And I think people deserve that story, that this is not your fault and politically. We need to do something about it because it is a mission or exposure to chemicals that we just allow companies to do. And I think that’s a huge problem. And if I were in politics, I would definitely look into this because you can do something about it, right? It’s easier compared to climate change where you are really depending on all of the countries doing something, whereas novel entities is more local, more regional. So if the issue is there where you emit the chemicals, right? So it’s easier to do something locally that will have an impact on the local population.

Frederik: So that’s a shorter path to harvesting the fruits of your work. If you do some of the hard cleaning up work now, you actually also get some of the benefits to put it in a very simplistic way. Yeah. Thanks a lot for rounding that up. Yeah. I think it is, the more you scratch the surface of a piece of the boundaries, the more difficult the problem seems to solve, I think, because it’s just so widespread across so many different fields and there’s so much luck in effect and path dependency and a lot of reluctance to change or resistance to change that is deeply rooted across the populations and across the different institutions and structures that are at play, which makes it humbling and difficult to look at. But although it is such a big issue, although we have the recent additions of the planetary boundary assessment and of course also the global political climate in its current state, there’s a lot of reasons to be put down, but despite the loud signals that things are going in the wrong direction, what gives you hope in times like these?

Mia: That’s a very good question. And some days I don’t have hope. Some days I do. Some days I feel I have to have hope because I’m a mom. And some days I need to close my eyes because it’s too much. Trump put in climate change. But I think the thing that I hold on to is that we have all the reason to fight for this. Like we cannot give up and now we are already at 1.5 degrees. So you could just give up or you could think that every tonne counts. And I think that’s the new narrative that we need. It’s much better to reach only two degrees, even though that’s horrible. That’s and then we haven’t even got to talk about the risk of reaching those tipping points. And I, we don’t have the time to deep dive into that, but we have this domino effect of some tipping points across the world. So we need to think that every tonne counts and that’s I don’t know if it gives me hope, but it gives me motivation and drive to continue. Yeah, because it’s gonna get worse and we know, and we need to get to adaptation instead of mitigation, unfortunately. But it definitely gives me some motivation to do my daily work considering this every tonne counts. So it does matter what we are doing.

Frederik: I think motivation and drive is close enough to what I was trying to get at. So I think if it’s not hope, then motivation and drive is fully acceptable.

Frederik: That was all we had time for today. Mia, thank you so much for taking time out of your calendar to share your views with our listeners and for putting in the work for the working paper. I’m just really grateful for that. We will include in the show notes links to your working paper. The papers you cited, if you’ll please help me with a link for that and for the Planetary Boundaries framework. So that is all available to the listeners through the show notes. For all of you listening, thank you so much for tuning in to this episode of the Sustainable Healthcare Podcast. My name is Frederik van Deurs. I’ve been your host today. Please rate the show, share it with your friends and colleagues, whoever should listen to it. And if there’s anyone you would like to hear on the show as a guest, do give us a note and we will do our best to get them on the show. I have a dream of Arnold [?]. I’m not sure if that’s going to happen before he or I dies. We will see who lived the longest, but anyone you would like to hear on the show, we would be happy to invite them. And once again, Mia, thank you so much for coming. I hope you have a great day in front of you.