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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.

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.

Despite the overwhelming evidence that living in poor-quality housing and built environments are significant contributors to public health problems, housing issues persist and represent a considerable societal and economic burden worldwide. The complex interaction between multiple behavioral, lifestyle, and environmental factors influencing health throughout the “life-course” (i.e., from childhood to adulthood) in high-income countries has limited the ability to develop more salutogenic housing interventions. The resultant, usually negative, health outcomes depend on many specific housing factors including housing quality and standards, affordability, overcrowding, the type of tenure and property. The immediate outdoor environment also plays an important role in health and wellbeing at the population level, which includes air (indoor and outdoor), noise pollution and the quality of accessible natural environments. These exposures are particularly important for more vulnerable populations, such as the elderly or infirm, and those living in insecure accommodation or in fuel poverty (i.e., being unable to heat the home adequately). Being homeless also is associated with increased risks in a number of health problems. Investigating pathways to protecting health and wellbeing has led to a range of studies examining the potential benefits resulting from accessing more natural environments, more sustainable communities, and housing interventions such as “green construction” techniques. Built environment interventions focusing on the provision of adequate housing designs that incorporate a “life-course” approach, affordable and environmentally sustainable homes, and urban regeneration along with active community engagement, appear capable of improving the overall physical and mental health of residents. While some interventions have resulted in improved public health outcomes in more high-income countries, others have led to a range of unintended consequences that can adversely affect residents’ health and wellbeing. Furthering understanding into four interrelated factors such as housing-specific issues, the immediate environment and housing, vulnerable populations, and natural spaces and sustainable communities can help to inform the development of future interventions.

The interdisciplinary study of oceans and human health is an area of increasing global importance. There is a growing body of evidence that the health of the oceans and that of humans are inextricably linked and that how we interact with and affect our oceans and seas will significantly influence our future on earth. Since the emergence of modern humans, the oceans have served as a source of culture, livelihood, expansion, trade, food, and other resources. However, the rapidly rising global population and the continuing alterations of the coastal environment are placing greater pressure on coastal seas and oceans. Negative human impacts, including pollution (chemical, microbial, material), habitat destruction (e.g., bottom trawling, dredging), and overfishing, affect not only ecosystem health, but also human health. Conversely, there is potential to promote human health and well-being through sustainable interactions with the coasts and oceans, such as the restoration and preservation of coastal and marine ecosystems. The study of oceans and human health is inherently interdisciplinary, bringing together the natural and social sciences as well as diverse stakeholder communities (including fishers, recreational users, private enterprise, and policymakers). Reviewing history and policy with regard to oceans and human health, in addition to known and potential risks and benefits, provides insights into new areas and avenues of global cooperation, with the possibility for collaboratively addressing the local and global challenges of our interactions with the oceans, both now and in the future.

The large and multidisciplinary literature on water for domestic use and gender has two primary foci: (1) the negative health and well-being impacts of inadequate access to safe water, and (2) the effects of women’s participation in water allocation and management decisions. These foci are reflected in both the research and policy literatures. Smaller bodies of work exist on water and social power, and on nonmaterial values and meanings of water. The term “gender” refers to the socially constructed roles and identities of girls, women, boys, men, and nonbinary people, but the literature on water and gender to date is mainly concerned with women and girls, on whom inadequate water access places a disproportionate burden. The water and health literature during the Millennium Development Goals era focused overwhelmingly on the consequences of unsafe drinking water for child health, while paying less attention to the health of the water carriers and managers. Studies on women’s participation in water-related decisions in the household or community were (and to some extent remain) mixed with respect to their effects on equity, access, and empowerment. Both the health and participation strands often assumed, implicitly or explicitly, that water work was women’s work. Yet data on access was mainly collected and presented by household or community, with little effort to disaggregate access and use by gender. In keeping with the spirit of the Sustainable Development Goals, the post-2015 literature has gone beyond a focus on infectious diseases to include the psychosocial stresses of coping with unreliable or inadequate water supplies. These stresses are acknowledged to fall disproportionately on women. A relatively small literature exists on the health impacts of carrying heavy loads of water and on the hard choices to be made when safe water is scarce. The negative impacts of inadequate domestic water access on girls’ education opportunities, on the safety of those who walk long distances to collect water, and on family conflicts have also been studied. Access is being defined beyond the household to prioritize safe water availability in schools and in healthcare facilities, both of which serve vulnerable populations. Both are institutional settings with a majority-female workforce. The definition of domestic water post-2015 has also broadened beyond drinking water to include water for cooking, sanitation, and basic hygiene, all of which particularly concern women’s well-being. Intersectionality with respect to gender, class, ability, and ethnicity has started to inform research, in particular research influenced by feminist political ecology and/or indigenous values of water. Political ecology has drawn attention to structural inequalities and their consequences for water access, a perspective that is upstream of public health’s concerns with health impacts. Research on participation is being augmented with studies of leadership and decision-making, both within communities as well as within the water sector. Critical studies of gender, water, and participation have argued that development agencies can limit modes of participation to those that “fit” their larger goals, e.g., efficiency and cost-recovery in drinking water systems. Studies have also analyzed the gendered burden of paying for safe water, especially as the pressure for cost recovery has grown within urban water policy. These are significant and growing new directions that acknowledge the breadth and complexities of the gender and water world; they do not simply call for gender-disaggregated data but attempt, albeit imperfectly, to take water research towards the recognition of gender justice as a foundation for water justice for all.