BACKGROUND: The Nature Step to Respiratory Health was the overarching theme of the 12th General Meeting of the Global Alliance against Chronic Respiratory Diseases (GARD) in Helsinki, August 2018. New approaches are needed to improve respiratory health and reduce premature mortality of chronic diseases by 30% till 2030 (UN Sustainable Development Goals, SDGs). Planetary health is defined as the health of human civilization and the state of the natural systems on which it depends. Planetary health and human health are interconnected, and both need to be considered by individuals and governments while addressing several SDGs. RESULTS: The concept of the Nature Step has evolved from innovative research indicating, how changed lifestyle in urban surroundings reduces contact with biodiverse environments, impoverishes microbiota, affects immune regulation and increases risk of NCDs. The Nature Step calls for strengthening connections to nature. Physical activity in natural environments should be promoted, use of fresh vegetables, fruits and water increased, and consumption of sugary drinks, tobacco and alcohol restricted. Nature relatedness should be part of everyday life and especially emphasized in the care of children and the elderly. Taking "nature" to modern cities in a controlled way is possible but a challenge for urban planning, nature conservation, housing, traffic arrangements, energy production, and importantly for supplying and distributing food. Actions against the well-known respiratory risk factors, air pollution and smoking, should be taken simultaneously. CONCLUSIONS: In Finland and elsewhere in Europe, successful programmes have been implemented to reduce the burden of respiratory disorders and other NCDs. Unhealthy behaviour can be changed by well-coordinated actions involving all stakeholders. The growing public health concern caused by NCDs in urban surroundings cannot be solved by health care alone; a multidisciplinary approach is mandatory.

Allergy and Asthma Network Vienna VA USA

Clinic of Children's Diseases Institute of Clinical Medicine and Department of Public Health Institute of Health Sciences Vilnius University Vilnius Lithuania

Department of Dermatology Allergology and Venereology Helsinki University Hospital Helsinki Finland

Department of Medicine University of Cape Town Cape Town South Africa

Department of Medicine University of Illinois at Chicago Chicago USA

Department of Pediatrics Medical School Federal University of Minas Gerais Belo Horizonte Brazil

Department of Prevention of Environmental Hazards and Allergology Medical University of Warsaw Warsaw Poland

Department of Public Health and Primary Care Leiden University Medical Center Leiden The Netherlands

Department of Pulmonary Diseases Cerrahpasa Faculty of Medicine Istanbul University Cerrahpasa Istanbul Turkey

Department of Pulmonary Diseases Faculty of Medicine Celal Bayar University Manisa Turkey

Department of Respiratory Diseases and Tuberculosis University Hospital Olomouc Olomouc Czech Republic

Department of Respiratory Medicine National Institute of Diseases of the Chest and Hospital Dhaka Bangladesh

Department of Thoracic Diseases Ain Shams Faculty of Medicine Abbassia Cairo Egypt

Dept of Pulmonary Medicine Postgraduate Institute of Medical Education and Research Chandigarh India

Division of Allergology and Respiratory Medicine Showa University School of Medicine Tokyo Japan

Division of Internal Medicine Asthma and Allergy Barlicki University Hospital Medical University of Lodz Lodz Poland

Environmental Policy Centre Finnish Environment Institute Helsinki Finland

EuroAsian Respiratory Society Astana City Kazakhstan

FILHA Finnish Lung Health Association Helsinki Finland

Global Allergy and Asthma Patient Platform Vienna Austria

Global Alliance Against Chronic Respiratory Diseases Geneva Switzerland

Global Alliance Against Respiratory Diseases Helsinki Finland

Hispanic American Allergy Asthma and Immunology Association Marina Del Rey California USA

Hospital Dr Agostinho Neto Praia Cabo Verde

Hospital Universitario y Facultad de Medicina Monterrey Nuevo Leon Mexico

Immunoallergology Department Hospital da Luz Lisboa Lisbon Portugal

Investigaciones en Alergia y Enfermedades Respiratorias Buenos Aires Argentina

ISGlobAL Centre for Research in Environmental Epidemiology Barcelona Spain

Istituto di Fisiologia Clinica CNR Pisa Italy

Istituto per la Ricerca e l'Innovazione Biomedica Palermo Italy

Kyrgyzstan National Centre of Cardiology and Internal Medicine Euro Asian Respiratory Society Bishkek Kyrgyzstan

Laboratory of Clinical Immunology Department of Microbiology and Immunology KU Leuven Louvain Belgium

Life and Health Sciences Research Institute ICVS School of Medicine University of Minho Braga Portugal

MACVIA France Fondation Partenariale FMC VIA LR CHRU Arnaud de Villeneuve Montpellier France

Management of NCDs WHO Geneva Switzerland

National Center for Research in Chronic Respiratory Diseases Tishreen University School of Medicine Latakia Syria

National Institute for Health and Welfare Helsinki Finland

National Institute of Pneumology M Nasta Bucharest Romania

ProAR Nucleo de Excelencia em Asma Federal University of Bahia Vitória Da Conquista Brazil

Pulmonology Department Ivane Javakhishvili Tbilisi State University Chapidze Emergency Cardiology Center Tbilisi Georgia

Pulmonology Department Maputo Central Hospital Maputo Mozambique

Respiratory Care Center University Medical Center Ho Chi Minh City Vietnam

Shahid Beheshti University of Medical Sciences Tehran Iran

Skin and Allergy Hospital Helsinki University Hospital University of Helsinki Helsinki Finland

The Allergy and Asthma Institute Islamabad Pakistan

The Hospital for Sick Children Research Institute and Della Lana School of Public Health University of Toronto Toronto ON Canada

Zhongshan Hospital Fudan University Shanghai Respiratory Research Institute Shanghai China

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