Eco-affective health as a missing pillar of planetary health leadership.

Planetary health leadership increasingly depends on the capacity to sustain engagement, legitimacy and long-term action under accelerating environmental change. While leadership frameworks in planetary health have advanced in addressing governance, systems transformation and sustainability practices, they have largely overlooked a foundational dimension through which environmental change is experienced and acted on: affect. This commentary introduces an eco-affective health-informed leadership perspective, arguing that emotional responses to environmental change, such as distress, fatigue, loss and hope, are not peripheral or individual-level phenomena but system-level signals that shape policy acceptance, institutional endurance and behavioural persistence within health systems. Drawing on evidence from sustainability science, public health and affective research, the paper reframes eco-affective dynamics as sources of strategic insight rather than obstacles to be managed or medicalised. A concise leadership-oriented framework is presented to support planetary health leaders in recognising, interpreting and responding to eco-affective signals across institutions, communities and policy environments, with practical implications for governance, decision-making and health system resilience. By integrating eco-affective health into planetary health leadership, this commentary advances a human-centred approach to leading through environmental disruption, positioning lived experience as central to the durability, legitimacy and effectiveness of planetary health action.