Health and the Environment Introduction

1. Ramona Sunderwirth MD MPH Global Health Fellowship Lecture Series Health and the Environment Introduction

2. 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

3. 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

4. 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)

5. 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

6. 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

7. 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

8. 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

9. 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

10. Brief History of the World

11. 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

12. 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

13. 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

14. 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

15. 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

16. 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

17. 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

18. 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

19. 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

20. Global Environmental Change & Population Health • Climate Change • Stratospheric Ozone depletion • Biodiversity: Losses & Invasions • Land Degradation, food & Malnutrition • Persistent Organic Pollutants • Exporting Hazards

21. 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

22. 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

23. Environmental Worldviewsfor understanding environmental concerns • Market liberals • Institutionalists • Bioenvironmentalists • Social Greens

24. 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

25. 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

26. 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

27. 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)

28. Ecological FootprintBill 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)

29. 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)

30. 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

31. 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

32. 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)

36. 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

37. 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

38. 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”

41. 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)

42. 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.393-397) 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