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.
Hans Keune and Timo Assmuth
George Morris and Patrick Saunders
Most people today readily accept that their health and disease are products of personal characteristics such as their age, gender, and genetic inheritance; the choices they make; and, of course, a complex array of factors operating at the level of society. Individuals frequently have little or no control over the cultural, economic, and social influences that shape their lives and their health and well-being. The environment that forms the physical context for their lives is one such influence and comprises the places where people live, learn work, play, and socialize, the air they breathe, and the food and water they consume. Interest in the physical environment as a component of human health goes back many thousands of years and when, around two and a half millennia ago, humans started to write down ideas about health, disease, and their determinants, many of these ideas centered on the physical environment. The modern public health movement came into existence in the 19th century as a response to the dreadful unsanitary conditions endured by the urban poor of the Industrial Revolution. These conditions nurtured disease, dramatically shortening life. Thus, a public health movement that was ultimately to change the health and prosperity of millions of people across the world was launched on an “environmental conceptualization” of health. Yet, although the physical environment, especially in towns and cities, has changed dramatically in the 200 years since the Industrial Revolution, so too has our understanding of the relationship between the environment and human health and the importance we attach to it. The decades immediately following World War II were distinguished by declining influence for public health as a discipline. Health and disease were increasingly “individualized”—a trend that served to further diminish interest in the environment, which was no longer seen as an important component in the health concerns of the day. Yet, as the 20th century wore on, a range of factors emerged to r-establish a belief in the environment as a key issue in the health of Western society. These included new toxic and infectious threats acting at the population level but also the renaissance of a “socioecological model” of public health that demanded a much richer and often more subtle understanding of how local surroundings might act to both improve and damage human health and well-being. Yet, just as society has begun to shape a much more sophisticated response to reunite health with place and, with this, shape new policies to address complex contemporary challenges, such as obesity, diminished mental health, and well-being and inequities, a new challenge has emerged. In its simplest terms, human activity now seriously threatens the planetary processes and systems on which humankind depends for health and well-being and, ultimately, survival. Ecological public health—the need to build health and well-being, henceforth on ecological principles—may be seen as the society’s greatest 21st-century imperative. Success will involve nothing less than a fundamental rethink of the interplay between society, the economy, and the environment. Importantly, it will demand an environmental conceptualization of the public health as no less radical than the environmental conceptualization that launched modern public health in the 19th century, only now the challenge presents on a vastly extended temporal and spatial scale.
Knowledge of the important role that the environment plays in determining human health predates the modern public health era. However, the tendency to see health, disease, and their determinants as attributes of individuals rather than characteristics of communities meant that the role of the environment in human health was seldom accorded sufficient importance during much of the 20th century. Instead, research began to focus on specific risk factors that correlated with diseases of greatest concern, i.e., the non-communicable diseases such as cardiovascular disease, asthma, and diabetes. Many of these risk factors (e.g., smoking, alcohol consumption, and diet) were aspects of individual lifestyle and behaviors, freely chosen by the individual. Within this individual-centric framework of human health, the standard economic model for human health became primarily the Grossman model of health and health care demand. In this model, an individual’s health stock may be increased by investing in health (by consuming health services, for example) or decreased by endogenous (age) or exogenous (smoking) individual factors. Within this model, individuals used their available resources, their budget, to purchase goods and services that either increased or decreased their health stock. Grossman’s model provides a consumption-based approach to human health, where individuals purchase goods and services required to improve their individual health in the marketplace. Grossman’s model of health assumes that the goods and services required to optimize good health can be purchased through market-based interactions and that these goods and services are optimally priced—that the value of the goods and services are reflected in their price. In reality, many types of goods and services that are good for human health are not available to purchase, or if they are available they are undervalued in the free market. Across the environmental and health literature, these goods and services are, today, broadly referred to as “ecosystem services for human health.” However, the quasi-public good nature of ecosystem services for human health means that the private market will generate a suboptimal environment for both individual and public health outcomes. In the face of continued austerity and scarce public resources, understanding the role of the environment in human health may help to alleviate future health care demand by decreasing (or increasing) environmental risk (or benefits) associated with health outcomes. However, to take advantage of the role that the environment plays in human health requires a fundamental reorientation of public health policy and spending to include environmental considerations.
Maria Cristina Fossi and Cristina Panti
A vigorous effort to identify and study sentinel species of marine ecosystem in the world’s oceans has developed over the past 50 years. The One Health concept recognizes that the health of humans is connected to the health of animals and the environment. Species ranging from invertebrate to large marine vertebrates have acted as “sentinels” of the exposure to environmental stressors and health impacts on the environment that may also affect human health. Sentinel species can signal warnings, at different levels, about the potential impacts on a specific ecosystem. These warnings can help manage the abiotic and anthropogenic stressors (e.g., climate change, chemical and microbial pollutants, marine litter) affecting ecosystems, biota, and human health. The effects of exposure to multiple stressors, including pollutants, in the marine environment may be seen at multiple trophic levels of the ecosystem. Attention has focused on the large marine vertebrates, for several reasons. In the past, the use of large marine vertebrates in monitoring and assessing the marine ecosystem has been criticized. The fact that these species are pelagic and highly mobile has led to the suggestion that they are not useful indicators or sentinel species. In recent years, however, an alternative view has emerged: when we have a sufficient understanding of differences in species distribution and behavior in space and time, these species can be extremely valuable sentinels of environmental quality. Knowledge of the status of large vertebrate populations is crucial for understanding the health of the ecosystem and instigating mitigation measures for the conservation of large vertebrates. For example, it is well known that the various cetacean species exhibit different home ranges and occupy different habitats. This knowledge can be used in “hot spot” areas, such as the Mediterranean Basin, where different species can serve as sentinels of marine environmental quality. Organisms that have relatively long life spans (such as cetaceans) allow for the study of chronic diseases, including reproductive alterations, abnormalities in growth and development, and cancer. As apex predators, marine mammals feed at or near the top of the food chain. As the result of biomagnification, the levels of anthropogenic contaminants found in the tissues of top predators and long-living species are typically high. Finally, the application of consistent examination procedures and biochemical, immunological, and microbiological techniques, combined with pathological examination and behavioral analysis, has led to the development of health assessment methods at the individual and population levels in wild marine mammals. With these tools in hand, investigators have begun to explore and understand the relationships between exposures to environmental stressors and a range of disease end points in sentinel species (ranging from invertebrates to marine mammals) as an indicator of ecosystem health and a harbinger of human health and well-being.
Rachel N. McInnes
Allergenic pollen is produced by the flowers of a number of trees, grasses, and weeds found throughout the world. Human exposure to such pollen grains can exacerbate pollen-related asthma and allergenic conditions such as allergic rhinitis (hay fever). While allergenic pollen comes from three main groups of plants—certain trees, grasses, and weeds—many people are sensitive to pollen from one or a few taxa only. Weather, climate, and environmental conditions have a significant impact on the levels and varieties of pollen grains present in the air. These allergenic conditions significantly reduce the quality of life of affected individuals and have been shown to have a major economic impact. Pollen production depends on both the current meteorological conditions (including day length, temperature, irradiation, precipitation, and wind speed/direction), and the water availability and other environmental and meteorological conditions experienced in the previous year. The climate affects the types of vegetation and taxa that can grow in a particular location through availability of different habitats. Land-use or land management is also crucial, and so this field of study has implications for vegetation management practices and policy. Given the influential effects of weather and climate on pollen, and the significant health impacts globally, the total effect of any future environmental and climatic changes on aeroallergen production and spread will be significant. The overall impact of climate change on pollen production and spread remains highly uncertain, and there is a need for further understanding of pollen-related health impact information. There are a number of ways air quality interacts with the impact of pollen. Further understanding of the risks of co-exposure to both pollen and air pollutants is needed to better inform public health policy. Furthermore, thunderstorms have been linked to asthma epidemics, especially during the grass pollen seasons. It is thought that allergenic pollen plays a role in this “thunderstorm asthma.” To reduce the exposure to, or impact from, pollen grains in the air, a number of adaptation and mitigation options may be adopted. Many of these would need to be done either through policy changes, or at a local or regional level, although some can be done by individuals to minimize their exposure to pollen they are sensitive to. Improved aeroallergen forecast models could be developed to provide detailed taxon-specific, localized information to the public. One challenge will be combining the many different sources of aeroallergen data that are likely to become available in future into numerical forecast systems. Examples of these potential inputs are automated observations of aeroallergens, real-time phenological observations and remote sensing of vegetation, social sensing, DNA analysis of specific aeroallergens, and data from symptom trackers or personal monitors. All of these have the potential to improve the forecasts and information available to the public.
Michael N. Moore
Humans have been exposed to naturally occurring toxic chemicals and materials over the course of their existence as a species. These materials include various metals, the metalloid arsenic, and atmospheric combustion particulates, as well as bacterial, fungal, algal, and plant toxins. They have also consumed plants that contain a host of phytochemicals, many of which are believed to be beneficial, such as plant polyphenols. People are exposed to these various substances from a number of sources. The pathways of exposure include air, water, groundwater, soil (including via plants grown in toxic soils), and various foods, such as vegetables, fruit, fungi, seafood and fish, eggs, wild birds, marine mammals, and farmed animals. An overview of the various health benefits, hazards and risks relating to the risks reveals the very wide variety of chemicals and materials that are present in the natural environment and can interact with human biology, to both its betterment and detriment. The major naturally occurring toxic materials that impact human health include metals, metalloids (e.g., arsenic), and airborne particulates. The Industrial Revolution is a major event that increased ecosystem degradation and the various types and duration of exposure to toxic materials. The explosions in new organic and organometallic products that were and still are produced over the past two centuries have introduced new toxicities and associated pathologies. The prevalence in the environment of harmful particulates from motor-vehicle exhaust emissions, road dust and tire dust, and other combustion processes must also be considered in the broader context of air pollution. Natural products, such as bacterial, fungal, algal, and plant toxins, can also have adverse effects on health. At the same time, plant-derived phytochemicals (i.e., polyphenols, terpenoids, urolithins, and phenolic acids, etc.) also have beneficial and potential beneficial effects, particularly with regard to their anti-inflammatory effects. Because inflammation is associated with most disease processes, phytochemicals that have antioxidant and anti-inflammatory properties are of great interest as potential nutraceuticals. These potentially beneficial compounds may help to combat various cancers; autoimmune conditions; neurodegenerative diseases, including dementias; and psychotic conditions, such as depression, and are also essential micronutrients that promote health and well-being. The cellular and molecular mechanisms in humans that phytochemicals modulate, or otherwise interact with, to improve human health are now known. In the early 21st century, some of the current pollution issues are legacy problems from past industrialization, such as mercury and persistent organic pollutants (POPs). These POPs include many organochlorine compounds (e.g., polychlorinated biphenyls, pesticides, polychlorinated and polybrominated dibenzo-dioxans and -furans), as well as polycyclic aromatic hydrocarbons (PAHs), nitro-PAHs, and others. The toxicity of chemical mixtures is still a largely unknown problem, particularly with regard to possible synergies. The continuing development of new organic chemicals and nanomaterials is an important environmental health issue; and the need for vigilance with respect to their possible health hazards is urgent. Nanomaterials, in particular, pose potential novel problems in the context of their chemical properties; humans have not previously been exposed to these types of materials, which may well be able to exploit gaps in our existing cellular protection mechanisms. Hopefully, future advances in knowledge emerging from combinatorial chemistry, molecular modeling, and predictive quantitative structure-activity relationships (QSARs), will enable improved identification of the potential toxic properties of novel industrial organic chemicals, pharmaceuticals, and nanomaterials before they are released into the natural environment, and thus prevent a repetition of past disastrous events.
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.