Download Health and the Environment Introduction

Ramona Sunderwirth MD MPH
Global Health Fellowship
Lecture Series
Objectives
Definitions , Concepts & Scope of the
environmental impact on health
 Brief History of political ecology
 Environmental World Views
 Scale & distribution of environmental
risks to health

Definitions of Environment

Refers to our natural surroundings & their
resources + built conditions + social relations

The combined exposures & processes that
impinge on individuals & groups

Are beyond the immediate control of
individuals
Definitions & Scope

Natural environment
 Physical, chemical, biological factors & processes
external to people

Built environment
 Human made settings – buildings, housing,
sanitation, transportation systems – all settings

Social environment
 Conditions w/in which people live, shaped by
cultural, social, economic, political relations &
factors

Sources: Evans (2002);Pruss-Ustiin & Corvlan (2006)
Definitions & Scope

Ecology
 Study of relationships & interactions btw living
organisms & their environment

Ecosystem
 System formed by the interaction of a community
of organisms & their natural environment
geographically defined

Political ecology
 Understanding of the relationship & tensions btw
natural (environment) & human led change
Environment: Categorized

Environmental media
 Air, water, soil & food

Economic sector
 Transport, land use, energy generation

Physical scale
 Local, regional, global

Setting
 Household, working place, urban environment

Disease outcome
 Infections, cancers, chronic diseases, endocrine
disruptions, behavior/mental health, congenital anomalies

Cross scale
 Scale at which an environmental health impact occurs
may not be the scale at which the exposure was initiated
Environment definitional considerations:
Environmental Exposures

Natural exposures
 Seasonal, latitudinal, altitudinal gradients in solar
irradiation
 Extremes of hot/cold weather
 Physical disasters
 Local micronutrient deficiencies in soil

Human interventions
 Chemical contaminants → air, water, soil, food, work
place
 Physical hazards: ionizing radiation, urban noise,
road trauma
Major Environmental concerns

Industrialized countries
 Chemical contaminants→ regional, global air/water/soil/food
 Physical hazards (ionizing radiation, urban noise, road
trauma)
 Hazards controlled by major investments in housing,
community infra structure (drinking water supply, sewerage,
solid waste collection, etc)

Low & middle income countries




Microbiological quality of drinking water/food
Physical safety of housing/work
Indoor air pollution
Road hazards
Qualitative Dimensions

Familiar local physiochemical &
microbiological environment
 As vehicle for specific hazards → injury, toxicity,
nutritional deficiencies, infections

Emerging disruptions to the biosphere’s
ecological & geophysical system
 life support systems → stabilize, replenish, recycle, cleanse,
produce → climatic stability, food yields, clean freshwater,
nutrient cycling, sustain biodiversity
Brief History of the World
Interactions of humans w/ the natural
& built environments
Long term survival: maintaining assets of natural
environment
 All civilizations have subsumed nature in their
quest for progress
 Hunter gatherer societies (150,000yrs)

 Lived w/in limits local environments, moving nearby as needed

Agriculturalism (10-15,000yrs ago)
 Initial human efforts to control environment
 Transformed social & economic relations
 Land productivity ↑, crop surpluses
 Water irrigated, more land cleared
History

Cities (5,000 yrs ago)
 Society more stratified by wealth/power
 Wars over territory & resources
 Class of leaders vs peasants/slaves
 Testaments to wealth/power: Monuments, precious




metals/minerals
Early systems of commerce & extractive industries, trade
grows
Energy use: mined coal, wood burning
Cities grow → urban filth, rats→ Black Death (Plague)
Decline/abandonment of ancient cities: overgrazing/misuse
History

Feudalism & Industry→ Colonialism
 ↑ exploitation of natural resources & extractive
industries
 Distant lands for resources, labor, wealth & power
 Military conquest & political subjugation of peoples
 Environmental occupation
○ Strain on local environments: forest clearing, mining,
building transport routes → nefarious health effects on
local populations
History

Mercantilism→ Capitalism
 Colonial market system based on sale & circulation of
labor & products yielded huge profits
 + scientific/ technical advances in
production/transport/ communications
 + social policies pushing peasants off the land►
 Capitalism based on private ownership of enterprise &
free market economic principles
History

Industrial Revolution
 ↑energy use, urban immiseration →environmental
damage:
 Sulfur, chlorine, ammonia, methane → backened
air/lungs
 Water contamination: industrial/human/animal waste
 Deadly mix of environmental contamination &
dangerous occupational & living conditions → hi
mortality rates cholera, diarrhea, TB, etc
Industrial Capitalism → Electronic Era & Globalization
History

Worker struggles → modern environmental
movements
 Against noxious working & living conditions

Scale & character of European imperial enterprise
made its environmental impact far larger than other
civilizations (Chinese, Egyptian, Greek, Roman, Inca)

Industrial production, urban degradation, large
scale depletion & contamination of life’s essentials
(air, forests, groundwater, & soil) have continued, shaped
& strained by economic, social & military exploits
Forces driving global economy
 Industrial & agricultural production
 Resource exploitation & contamination
 Energy extraction & use
 Transportation & building patterns
 Militarism
 Inadequate regulation
 Market driven consumption patterns

↑ pressure on built & natural environments

Ecosystem & built environment alterations →
range of direct, mediated & indirect human health
consequences
Environmental health problems
in developing world

Have become even worse than in developed
world

Economic processes of recent decades
→accelerated industrialization, commerce,
migration, exploitation & extraction from Asia, L.
America, Africa
Environmental Threats


Household Exposures
 Sanitation & clean
drinking water
 Solid household fuels
 Housing quality
Workplace Environment
 Agriculture
 Mining & Extraction
 Construction
 Manufacturing
 Service Occupations


Community level Exposure
 Outdoor air quality
 Traffic & transport
 Industry & manufacturing
 Waste management
 Microbial & chemical
contamination or water & food
 Urbanization
Regional Exposures:
Transboundary
 Atmospheric dispersion of
contaminants
 Land use & water Engineering
Global Environmental Change &
Population Health
Climate Change
 Stratospheric Ozone depletion
 Biodiversity: Losses & Invasions
 Land Degradation, food & Malnutrition
 Persistent Organic Pollutants
 Exporting Hazards

Magnitude of environmental change
(Tony McMichael 2001)

During the 20th century we humans





↑2x our average life expectancy
↑4x the size of our population
↑ x 6 the global food yield & water consumption
↑ x 12 the production of carbon dioxide
↑ x 20 overall level of economic activity
In so doing we had, by the end of the century,
exceeded the planet’s carrying capacity by 30%
 That is, we are now operating in ecological deficit
 These rates of change in human demography,
economic activity, and environmental conditions are
unprecedented in history

Responses to determinants & effects

Sustained political & organized
responses can mitigate or reverse
underlying forces/pressures,
environmental changes & health
consequences at household, municipal,
ecosystem & larger political levels
Environmental Worldviews
for understanding environmental concerns

Market liberals

Institutionalists

Bioenvironmentalists

Social Greens
Market Liberals



Neoliberal economics
“economic growth & hi per capital incomes are essential for
human welfare & the maintenance of sustainable development”
Main cause of environmental degradation
 “lack of economic growth, poverty, distortions & failures of the market,
and bad policies”




Voluntary corporate efforts will improve environmental
managements
Reject catastrophic urgency of environmental degradation
Emphasize scientific approaches to problems based on
ingenuity, technology & cooperation
STO, World Business Council for Sustainable Development
Institutionalists

Market liberal assumptions for economic growth, trade,
foreign investment technology

“emphasize the need for stronger global institutions &
norms as well as sufficient state & local capacity to
constrain & direct the global political economy”
Improved global governance & consensus building →
enhance environmental cooperation & managements
 Support diffusion of knowledge & resources from
developed to developing countries and collective
action to forestall environmental deterioration

Bioenvironmentalists

Scientific activists

“Human (pop growth & patterns consumption )
consume too much of planet’s finite/fragile
resources, earth’s capacity to sustain this level of
consumption already/soon reached”

Solutions to environmental degradation
 Limits to economic growth, curbs on immigration to hi
consumption countries, individual approaches to
lowered consumption & family planning
Social Greens
Political, economic & environmental problems
inseparable
 Physical limits to economic growth
 Overconsumption in industrialized countries is
(partially) to blame
 Reject positions on pop growth (control) as assault
on rights of women & marginalized peoples
 Major overhaul of the global economic social
system to ↓ inequalities, & advocate the
abandonment of industrial & capitalist life

Clapp & Dauvergne (2005)
Ecological Footprint
Bill Rees &Mathis Wackernagle (1996)

Translates human consumption of renewable
natural resources into hectares of average
biologically productive land
(Dauvergne 2005)

Gauge the rate at which consumption patterns
compare to the natural environment’s ability to
renew itself
 Consumption patterns require over 20% more
ecological productivity /per person that the earth’s
biocapacity can sustain (WWLF 2001) (Loh & Wackernagel 2004)
Ecological Footprint

Individual’s ecological footprint
 Total area in productive hectares required to sustain a way of
life (food/water/energy/household materials/other/services)

Global ecological footprint
 Changes w/ average consumption per person, resource
efficiency & pop size
 WWLF 2001: estimated was 13.5B global hectares
(2.2global hectares/person), with 11.3B global biologically
productive hectares (1.8 hectares/person)
Carbon footprints
 Reflect bioenvironmentalist view (human consumption &

behavior change at the center of environmental strategy)
Scale & Distribution of Environmental
Risks to Health

Relative importance of environmental exposure as
cause of human disease & premature death remains
contentious
 Knowledge of disease etiology incomplete
 Statistic is moving target:
 Latency period (for nonacute outcomes)
 Past exposures that have changed/ceased

Complex bidirectional relationships
 Environmental conditions, socioeconomic
circumstances, demographic change & human health
 Difficulty estimating the environmental contribution to
disease burden
Environmental Risk Transition
Smith 1997
Environmental health risks shift during the economic
development process
 Risks in low & middle income societies

 Dominated by poor food, water, & air quality
 Household level
 Poor sanitation, contaminated water, low quality fuels
 Activities that solve these problems→ Community problems
○ urban air pollution, hazardous waste, chemical pollution

Industrialized societies
 Household and community problems have come under control
 Problems → Global scale
○ Greenhouse gas emissions
Characteristics of Environmental
Risk Transition

Economic Development
→Environmental Risk Transitions
→Epidemiological transition (shift in diseases)

Shift in Temporal Scale: Latency
→Infectious diseases (short period btw exposure &
disease)
→Cancer, chronic non infectious diseases (long)
Estimates of Environmental contribution to the total
avoidable global burden of disease

World Bank (1993): 1ST Systematic use of a standard metric (DALY)
 50% all global DALYs to diseases associated w/ environmental
exposures in households
 30% additional to diseases associated w/ the community environment
 Only small % deemed amenable to feasible preventive interventions

Rio Earth Summit, WHO, 1992
 25% global DALYs caused by environmental/workplace hazards

Smith, Corvalan, & Kjellstrom (1999)
 25-30% global burden of disease & premature death attributable to direct
environmental risk factors

World Health Report, WHO, 2002
World Health Report 2002 (WHO)
1st truly integrated comparative risk assessment
of global & regional burden of disease due to
major risk factors
 Compared w/ nonenvironmental hazards (smoking,

unsafe sex, malnutrition, HTA)

Environmental hazards
 Unsafe water, sanitation, & hygiene
 Urban air pollution
 Indoor smoke from solid fuels
 Lead exposure
 Climate change
 5 types occupational risks
World Health Report

Low & middle income countries
 Largest environmental health burden
○ Significant household level risks, ↓ w/ development
○ Young children particularly affected
○ Community level environmental risks (urban air pollution) ↑ w/
development, then ↓

Rich countries
 Environment least important factor in illness
 Behavioral risks dominate (smoking, diet, physical activity, etc)

Global level risks (climate change)
 Highest in poor countries
 Greenhouse gases emitting activities in rich countries→
 “environmental risk transition”
Global Statistical Data

Increasingly ambitious & sophisticated &
multidisciplinary

Health & Environment-related Indicators (MDG monitoring)
→Global & national time trend analyses for certain
environmental health hazards
# proportions of pop w/ sustainable access to
improved water source & sanitation
using solid fuels
access to secure residential tenure (slum patterns)
Bibliography
Birn, Anne Emanuelle, Pillay, Yogan, (2009) Textbook of
International Health Global Health in a Dynamic World
M Merson, R Black, (2006) International Public Health (pp.393397)
Rodgers A, Ezzati M, Vander Hoorn S, Lopez AD, Lin R-B, et al.
2004 Distribution of Major Health Risks: Findings from the
Global Burden of Disease Study. PLoS Med 1(1): e27.
doi:10.1371/journal.pmed.0010027
Smith K, Ezzati M, (2005) how environmental Health Risks
Change with Development Annu. Rev. Environ. Resour.
30:291-333
WHO Global Burden of Disease and Risk Factors DCPP