Environment and Human Health

Atmospheric brown clouds (ABCs) are widespread pollution clouds that can at times span an entire continent or an ocean basin. ABCs extend vertically from the ground upward to as high as 3 km, and they consist of both aerosols and gases. ABCs consist of anthropogenic aerosols such as sulfates, nitrates, organics, and black carbon and natural dust aerosols. Gaseous pollutants that contribute to the formation of ABCs are NOx (nitrogen oxides), SOx (sulfur oxides), VOCs (volatile organic compounds), CO (carbon monoxide), CH4 (methane), and O3 (ozone). The brownish color of the cloud (which is visible when looking at the horizon) is due to absorption of solar radiation at short wavelengths (green, blue, and UV) by organic and black carbon aerosols as well as by NOx. While the local nature of ABCs around polluted cities has been known since the early 1900s, the widespread transoceanic and transcontinental nature of ABCs as well as their large-scale effects on climate, hydrological cycle, and agriculture were discovered inadvertently by The Indian Ocean Experiment (INDOEX), an international experiment conducted in the 1990s over the Indian Ocean. A major discovery of INDOEX was that ABCs caused drastic dimming at the surface. The magnitude of the dimming was as large as 10–20% (based on a monthly average) over vast areas of land and ocean regions. The dimming was shown to be accompanied by significant atmospheric absorption of solar radiation by black and brown carbon (a form of organic carbon). Black and brown carbon, ozone and methane contribute as much as 40% to anthropogenic radiative forcing. The dimming by sulfates, nitrates, and carbonaceous (black and organic carbon) species has been shown to disrupt and weaken the monsoon circulation over southern Asia. In addition, the ozone in ABCs leads to a significant decrease in agriculture yields (by as much as 20–40%) in the polluted regions. Most significantly, the aerosols (in ABCs) near the ground lead to about 4 million premature mortalities every year. Technological and regulatory measures are available to mitigate most of the pollution resulting from ABCs. The importance of ABCs to global environmental problems led the United Nations Environment Programme (UNEP) to form the international ABC program. This ABC program subsequently led to the identification of short-lived climate pollutants as potent mitigation agents of climate change, and in recognition, UNEP formed the Climate and Clean Air Coalition to deal with these pollutants.

Mental and behavioral disorders account for approximately 7.4% of the global burden of disease, with depression now the world’s leading cause of disability. One in four people in the world will suffer from a mental health problem at some point in their life. City planning and design holds much promise for reducing this burden of disease, and for offering solutions that are affordable, accessible and equitable. Increasingly urban green space is recognized as an important social determinant of health, with the potential to protect mental health – for example, by buffering against life stressors - as well as relieving the symptom severity of specific psychiatric disorders. Pathways linking urban green space with mental wellbeing include the ability of natural stimuli – trees, water, light patterns – to promote ‘involuntary attention’ allowing the brain to disengage and recover from cognitive fatigue. This article brings together evidence of the positive effects of urban green space on common mental health problems (i.e. stress, anxiety, depression) together with evidence of its role in the symptom relief of specific psychiatric disorders, including schizophrenia and psychosis, post-traumatic stress disorder (PTSD), dementia, attention deficit/hyperactivity Disorder (ADHD) and autism. Urban green space is a potential force for building mental health: city planners, urban designers, policy makers and public health professionals need to maximize the opportunities in applying green space strategies for both health prevention and in supporting treatment of mental ill health.

Ecosystem services refer to benefits for human societies and well-being obtained from ecosystems. Research on health effects of ecosystem services have until recently mostly focused on beneficial effects on physical and mental health from spending time in nature or having access to urban green space. However, nearly all of the different ecosystem services may have impacts on health, either directly or indirectly. Ecosystem services can be divided into provisioning services that provide food and water; regulating services that provide, for example, clean air, moderate extreme events, and regulate the local climate; supporting services that help maintain biodiversity and infectious disease control; and cultural services.

With a rapidly growing global population, the demand for food and water will increase. Knowledge about ecosystems will provide opportunities for sustainable agriculture production in both terrestrial and marine environments. Diarrheal diseases and associated childhood deaths are strongly linked to poor water quality, sanitation, and hygiene. Even though improvements are being made, nearly 750 million people still lack access to reliable water sources. Ecosystems such as forests, wetlands, and lakes capture, filter, and store water used for drinking, irrigation, and other human purposes. Wetlands also store and treat solid waste and wastewater, and such ecosystem services could become of increasing use for sustainable development.

Ecosystems contribute to local climate regulation and are of importance for climate change mitigation and adaptation. Coastal ecosystems, such as mangrove and coral reefs, act as natural barriers against storm surges and flooding. Flooding is associated with increased risk of deaths, epidemic outbreaks, and negative health impacts from destroyed infrastructure. Vegetation reduces the risk of flooding, also in cities, by increasing permeability and reducing surface runoff following precipitation events.

The urban heat island effect will increase city-center temperatures during heatwaves. The elderly, people with chronic cardiovascular and respiratory diseases, and outdoor workers in cities where temperatures soar during heatwaves are in particular vulnerable to heat. Vegetation and especially trees help in different ways to reduce temperatures by shading and evapotranspiration. Air pollution increases the mortality and morbidity risks during heatwaves. Vegetation has been shown also to contribute to improved air quality by, depending on plant species, filtering out gases and airborne particulates. Greenery also has a noise-reducing effect, thereby decreasing noise-related illnesses and annoyances. Biological control uses the knowledge of ecosystems and biodiversity to help control human and animal diseases.

Natural surroundings and urban parks and gardens have direct beneficial effects on people’s physical and mental health and well-being. Increased physical activities have well-known health benefits. Spending time in natural environments has also been linked to aesthetic benefits, life enrichments, social cohesion, and spiritual experience. Even living close to or with a view of nature has been shown to reduce stress and increase a sense of well-being.

The emergence of environment as a security imperative is something that could have been avoided. Early indications showed that if governments did not pay attention to critical environmental issues, these would move up the security agenda. As far back as the Club of Rome 1972 report, Limits to Growth, variables highlighted for policy makers included world population, industrialization, pollution, food production, and resource depletion, all of which impact how we live on this planet.

The term environmental security didn’t come into general use until the 2000s. It had its first substantive framing in 1977, with the Lester Brown Worldwatch Paper 14, “Redefining Security.” Brown argued that the traditional view of national security was based on the “assumption that the principal threat to security comes from other nations.” He went on to argue that future security “may now arise less from the relationship of nation to nation and more from the relationship between man to nature.”

Of the major documents to come out of the Earth Summit in 1992, the Rio Declaration on Environment and Development is probably the first time governments have tried to frame environmental security. Principle 2 says: “States have, in accordance with the Charter of the United Nations and the principles of international law, the sovereign right to exploit their own resources pursuant to their own environmental and developmental policies, and the responsibility to ensure that activities within their jurisdiction or control do not cause damage to the environment of other States or of areas beyond the limits of national.”

In 1994, the UN Development Program defined Human Security into distinct categories, including:

• Economic security (assured and adequate basic incomes).

• Food security (physical and affordable access to food).

• Health security.

• Environmental security (access to safe water, clean air and non-degraded land).

By the time of the World Summit on Sustainable Development, in 2002, water had begun to be identified as a security issue, first at the Rio+5 conference, and as a food security issue at the 1996 FAO Summit. In 2003, UN Secretary General Kofi Annan set up a High-Level Panel on “Threats, Challenges, and Change,” to help the UN prevent and remove threats to peace. It started to lay down new concepts on collective security, identifying six clusters for member states to consider. These included economic and social threats, such as poverty, infectious disease, and environmental degradation.

By 2007, health was being recognized as a part of the environmental security discourse, with World Health Day celebrating “International Health Security (IHS).” In particular, it looked at emerging diseases, economic stability, international crises, humanitarian emergencies, and chemical, radioactive, and biological terror threats. Environmental and climate changes have a growing impact on health. The 2007 Fourth Assessment Report (AR4) of the UN Intergovernmental Panel on Climate Change (IPCC) identified climate security as a key challenge for the 21st century. This was followed up in 2009 by the UCL-Lancet Commission on Managing the Health Effects of Climate Change—linking health and climate change.

In the run-up to Rio+20 and the launch of the Sustainable Development Goals, the issue of the climate-food-water-energy nexus, or rather, inter-linkages, between these issues was highlighted. The dialogue on environmental security has moved from a fringe discussion to being central to our political discourse—this is because of the lack of implementation of previous international agreements.

Global environmental change amplifies and creates pressures that shape human migration. In the 21st century, there has been increasing focus on the complexities of migration and environmental change, including forecasts of the potential scale and pace of so-called environmental migration, identification of geographic sites of vulnerability, policy implications, and the intersections of environmental change with other drivers of human migration. Migration is increasingly viewed as an adaptive response to climatic and environmental change, particularly in terms of livelihood vulnerability and risk diversification. Yet the adaptive potential of migration will be defined in part by health outcomes for migrating populations. There has been limited examination, however, of the health consequences of migration related to environmental change.

Migration related to environmental change includes diverse types of mobility, including internal migration to urban areas, cross-border migration, forced displacement following environmental disaster, and planned relocation—migration into sites of environmental vulnerability; much-debated links between environmental change, conflict, and migration; immobile or “trapped” populations; and displacement due to climate change mitigation and decarbonization action. Although health benefits of migration may accrue, such as increased access to health services or migration away from sites of physical risk, migration—particularly irregular (undocumented) migration and forced displacement—can amplify vulnerabilities and present risks to health and well-being. For diverse migratory pathways, there is the need to anticipate, respond to, and ameliorate population health burdens among migrants.

While genomics has been founded on accurate tools that lead to a limited amount of classification error, exposure assessment in epidemiology is often affected by large error. The “environment” is in fact a complex construct that encompasses chemical exposures (e.g., to carcinogens); biological agents (viruses, or the “microbiome”); and social relationships. The “exposome” concept was then put forward to stress the relatively poor development of appropriate tools for exposure assessment when applied to the study of disease etiology. Three layers of the exposome have been proposed: “general external” (including social capital, stress and psychology); “specific external” (including chemicals, viruses, radiation, etc.); and “internal” (including for example metabolism and gut microflora). In addition, there are at least three properties of the exposome: (a) it is based on a refinement of tools to measure exposures (including internal measurements in the body); (b) it involves a broad definition of “exposure” or environment, including overarching concepts at a societal level; and (c) it involves a temporal component (i.e., exposure is analyzed in a life-course perspective). The conceptual and practical challenge is how the different layers (i.e., general, specific external, and internal) connect to each other in a causally meaningful sequence. The relevance of this question pertains to the translation of science into policy—for example, if experiences in early life impact on the adult risk of disease, and on the quality of aging, how is distant action to be incorporated in biological causal models and into policy interventions? A useful causal theory to address scientific and policy question about exposure is based on the concept of information transmission. Such a theory can explain how to connect the different layers of the exposome in a life-course temporal frame and helps identify the best level for intervention (molecular, individual, or population level). In this context epigenetics plays a key role, partly because it explains the long-distance persistence of epigenetic changes via the concept of “epigenetic memory.”

Framing and dealing with complexity are crucially important in environment and human health science, policy, and practice. Complexity is a key feature of most environment and human health issues, which by definition include aspects of the environment and human health, both of which constitute complex phenomena. The number and range of factors that may play a role in an environment and human health issue are enormous, and the issues have a multitude of characteristics and consequences. Framing this complexity is crucial because it will involve key decisions about what to take into account when addressing environment and human health issues and how to deal with them. This is not merely a technical process of scientific framing, but also a methodological decision-making process with both scientific and societal implications. In general, the benefits and risks related to such issues cannot be generalized or objectified, and will be distributed unevenly, resulting in health and environmental inequalities. Even more generally, framing is crucial because it reflects cultural factors and historical contingencies, perceptions and mindsets, political processes, and associated values and worldviews. Framing is at the core of how we as humans relate to, and deal with, environment and human health, as scientists, policymakers, and practitioners, with models, policies, or actions.