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The purpose of this paper is to explore the pressing issues facing health and health systems governance in the Anthropocene – a new geological time period that marks the age of colossal and rapid human impacts on Earth’s systems.

The viewpoint illustrates the extent of various human induced global ecological changes such as climate change and biodiversity loss and explores the social forces behind the new epoch. It draws together current scientific evidence and expert opinion on the Anthropocene’s health and health system impacts and warns that many these are yet unknown and likely to interact and compound each other.

Despite this uncertainty, health systems have four essential roles in the Anthropocene from adapting operations and preparing for future challenges to reducing their own contribution to global ecological changes and an advocacy role for social and economic changes for a healthier and more sustainable future.

To live up to this challenge, health services will need to expand from a focus on health governance to one on governance for health with a purpose of achieving equitable and sustainable human development.

As cities and local governments work to create more healthy, just and sustainable communities in the years ahead, health systems need to join with them as partners in that process, both as advocates and supporters and – through their own action within the health sector – as leading proponents and models of good practice.