In his keynote address on planetary health and physician leadership, colorectal surgeon Dr. Husein Moloo argued that health care leaders can no longer separate human health from environmental sustainability. Moloo framed planetary health as both an ethical responsibility and a practical leadership challenge, emphasizing that health care organizations must recognize the ecological determinants of health alongside the social determinants traditionally emphasized in medicine.

Moloo defined planetary health as the understanding that human well-being depends fundamentally on clean air, clean water, healthy soil, safe food systems, and ecological stability. He also stressed the importance of intergenerational responsibility, drawing on Indigenous teachings encouraging societies to think “seven generations ahead” and consider what kind of ancestors current leaders will become. Throughout the presentation, he repeatedly emphasized that climate change, biodiversity loss, and pollution together represent a “triple crisis” directly affecting both public health and health care delivery.

Using examples ranging from Canadian wildfires and severe storms to droughts in Europe and catastrophic flooding in Pakistan, Moloo illustrated how environmental instability is increasingly shaping lived experience globally. He then engaged the audience directly through an interactive word-cloud exercise asking participants how climate change made them feel. Responses such as “anxious,” “worried,” “hopeless,” and “terrified” mirrored similar exercises he had conducted with health care workers, students, and community groups. Moloo interpreted these reactions as manifestations of “eco-anxiety,” particularly among younger generations increasingly fearful about the future.

A central theme of this keynote address was that health care itself contributes substantially to environmental degradation. Moloo noted that if health care systems were considered a country, they would rank among the world’s largest carbon emitters, with Canada ranking fifth globally for health care-related emissions both overall and per capita. He emphasized that climate change affects nearly every organ system and intersects with respiratory disease, cardiovascular disease, infectious disease, mental health, and health inequities disproportionately affecting vulnerable populations.

Moloo argued that health care organizations whose missions focus on improving health can no longer ignore planetary health. In one of the presentation’s strongest statements, he asserted that if planetary health is absent from a health care organization’s mission and strategic planning, then “your vision and mission [are] irrelevant.” He stressed that planetary health need not replace traditional health care priorities but must become integrated into leadership, governance, and organizational decision-making.

Much of the presentation focused on practical examples of sustainability initiatives developed within health care settings. Moloo described how small quality improvement projects at The Ottawa Hospital evolved into broader organizational change. One initiative involved transitioning surgical services from paper faxing to electronic faxing, substantially reducing paper consumption across the institution. Another project, initiated by a medical student, examined replacing disposable surgical gowns with reusable cloth gowns. The initiative demonstrated no increase in infection rates while reducing costs by approximately $150 000 annually, ultimately leading to hospital-wide implementation. Moloo also described his team’s work challenging the routine use of sterile water during colonoscopy procedures despite the inherently non-sterile environment of the colon. After reviewing evidence and consulting infection control leadership, the team safely transitioned to non-sterile water without increased complications, reducing unnecessary resource use and costs. He emphasized that sustainable health care practices frequently align with financial stewardship and operational efficiency.

Beyond operational change, Moloo repeatedly returned to themes of reciprocity, courage, and kindness. Referencing Indigenous teachings, he encouraged health care leaders to reconsider humanity’s relationship with the natural world. He argued that viewing nature merely as a resource for exploitation contributes to environmental degradation, whereas recognizing interconnectedness fosters more responsible decision-making.

The address also highlighted the importance of leadership structures in driving change. Moloo described the creation of planetary health leadership positions within faculties of medicine, incorporation of planetary health into strategic plans at The Ottawa Hospital, and the integration of planetary health competencies into the CanMEDS framework. He emphasized that institutional governance signals legitimacy and creates permission for innovation and engagement among staff and learners.

Moloo concluded by encouraging health care leaders to embrace courageous conversations about sustainability within their organizations. Leadership, he argued, involves empowering learners, listening to innovative ideas, and recognizing that meaningful change often begins through small practical actions. He framed planetary health, not as a peripheral issue, but as a central leadership responsibility for modern health care systems.

Question-and-answer discussions further explored practical leadership challenges associated with sustainability initiatives. Responding to questions about institutional resistance, Moloo emphasized the importance of relationship-building, evidence-based dialogue, and identifying decision-makers capable of enabling organizational change. He also addressed strategies for engaging colleagues resistant to climate action, arguing that most health care professionals wish to contribute positively once concrete opportunities are available. A final discussion concerning the environmental impact of artificial intelligence highlighted the complexity of balancing technological innovation with sustainability goals, with Moloo acknowledging both the importance of the issue and the uncertainty surrounding future solutions.