Planetary health at a decade: from Bellagio to practice.

Introduction: In its first formally defined decade, the "planetary health" framing has had demonstrable impact but barriers to more radical action remain. Objectives: We reflect on progress during planetary health's first decade, identify barriers limiting its wider uptake and application, and propose pragmatic communication approaches for engaging health practitioners, policymakers and the public. Methods: We have drawn on our experience as two practitioners working at the nexus of climate and health, merging our perspective with a targeted literature search. Results: In its first ten years, the field of planetary health has shaped systems thinking and shown significant impact on curricula, research, funding and publications. Possible obstacles for achieving greater transformational change include abstraction, resource intensity of transdisciplinary research, inadequate integration of Indigenous and local knowledge, politics, and academic siloes. Safeguarding of human health requires a shift to integrated, systemic thinking that resonates beyond academia, and reframing of core messages to tailor to specific health practitioner, policymaker and public audiences. Conclusions: Planetary health is a valuable integrative paradigm, but actionable cross-sectoral translation of its conceptual ambition requires pragmatic operational guidance, flexible framing, and avoidance of over-complication and political obstruction. This next decade must prioritize translation and urgent, applied policy and practice action.