Introduction
Our project follows community requests for health service incorporation into conservation collaborations in the rainforests of Papua New Guinea (PNG). This protocol is for health needs assessments, our first step in coplanning medical provision in communities with no existing health data.

Methods and analysis
The study includes clinical assessments and rapid anthropological assessment procedures (RAP) exploring the health needs and perspectives of partner communities in two areas, conducted over 6 weeks fieldwork. First, in Wanang village (population c.200), which is set in lowland rainforest. Second, in six communities (population c.3000) along an altitudinal transect up the highest mountain in PNG, Mount Wilhelm. Individual primary care assessments incorporate physical examinations and questioning (providing qualitative and quantitative data) while RAP includes focus groups, interviews and field observations (providing qualitative data). Given absence of in-community primary care, treatments are offered alongside research activity but will not form part of the study. Data are collected by a research fellow, primary care clinician and two PNG research technicians. After quantitative and qualitative analyses, we will report: ethnoclassifications of disease, causes, symptoms and perceived appropriate treatment; community rankings of disease importance and service needs; attitudes regarding health service provision; disease burdens and associations with altitudinal-related variables and cultural practices. To aid wider use study tools are in online supplemental file, and paper and ODK versions are available free from the corresponding author.

Ethics and dissemination
Challenges include supporting informed consent in communities with low literacy and diverse cultures, moral duties to provide treatment alongside research in medically underserved areas while minimising risks of therapeutic misconception and inappropriate inducement, and PNG research capacity building. Brighton and Sussex Medical School (UK), PNG Institute of Medical Research and PNG Medical Research Advisory Committee have approved the study. Dissemination will be via journals, village meetings and plain language summaries.

The SURFACES project is integrating action on good health and wellbeing (Sustainable Development Goal [SDG] 3) and conservation of life on land (SDG 15) in the threatened rainforests of Papua New Guinea (PNG), and mapping evidence of similar projects worldwide. Our approach is framed by Planetary Health, aiming to safeguard both human health and the natural systems that underpin it. Our rationale is demonstrated through a summary of health needs and forest conservation issues across PNG, and how these play out locally. We outline differing types of integrated conservation and health interventions worldwide, providing examples from Borneo, Uganda, India and elsewhere. We then describe what we are doing on-the-ground in PNG, which includes expansion of a rainforest conservation area alongside the establishment of a nurse-staffed aid post, and an educational intervention conceptually linking forest conservation and health. Importantly, we explore some ethical considerations on the conditionality of medical provision, and identify key challenges to successful implementation of such projects. The latter include: avoiding cross-sectoral blindness and achieving genuine interdisciplinary working; the weak evidence base justifying projects; and temporal-spatial issues. We conclude by suggesting how projects integrating actions on health and conservation SDGs can benefit from (and contribute to) the energy of the emerging Planetary Health movement.

Background
New Guinea has the third largest tropical rainforest on Earth. However, one quarter of the forests of Papua New Guinea (PNG, New Guinea’s eastern half) have been cleared or degraded, nearly half through commercial logging.Sustainable development requires supporting good health (Sustainable Development Goal [SDG] 3) and protecting life on land (SDG 15). To remote communities in PNG with low levels of health provision, these goals can seem in conflict. Logging companies’ offer of roads and income can partly extinguish the remoteness that bars access to health services, making desire for health a driver for forest destruction and erosion of health related ecosystem services. Conservation success thus requires synergies be developed with delivery of other SDGs, particularly those pertaining to health. We aim to provide a model of integrated health and conservation in PNGs rainforests.

Methods
We are mapping and piloting biological, anthropological, and medical methods to address SDGs on health and biodiversity, focusing first on scabies and fungal diseases. At Wanang, team members have a long term collaboration with nine clans with unmet health needs who collectively chose to preserve their 10,000 hectare forest whilst surrounding communities allowed logging. Similar collaborations are being developed along an altitudinal transect on Mt.Wilheim (4,509m). Stage 1 of Surfaces will (i) systematically map evidence on integrated conservation and health programmes, (ii) conduct clinical examinations and rapid anthropological assessments to understand medical needs, and survey skin disease, and (iii) produce a case study of the Wanang agreement, based on interviews with participants. This will lay the foundation for a multi-year health intervention and interdisciplinary study.

Findings
We are in the projects’ early stages (so do not yet have findings), and would appreciate advice and suggestions of collaboration from others in the Planetary Health community.

Funding
Sussex Sustainability Research Programme, University of Sussex, UK.

Contributions
All authors have commented on multiple drafts and approved the final version of the abstract for publication.

Conflicts of interest
We declare we have no conflicts of interest.

Acknowledgments
We thank the projects partner communities; New Guinea Binatang Research Centre; and our advisory group.