Lessons from the strong global response to the coronavirus disease 2019 (COVID-19) pandemic and a renewed call for “One health” approach to health systems management in “The Lancet” parallel climate change emergencies. The weakened health - climate change nexus, perceived largely within public health need to engage how the Earth system (i.e. relationships between air, land, life and water on earth) in shaping the etiologies, incidences and transmission dynamics of diseases. The question “What are the drivers of the drivers of diseases?” using the context of diarrheal diseases is posed. Subsequently, we need to understand how (i) climatic risks drive biological health hazards, (ii) shifts in disease control services of ecosystems regulate diseases, (iii) climate change within Earth systems modify disease pathogens and species hosts relationships. Hence, safeguarding Earth system-related disease dynamics would inform pluralistic approaches beyond “One health”.