# Related [[@EnvironmentHealthDev2016]] # Introduction ## Environmental transition In a given country or population, economic development generally improves living standards, infrastructure and health service provision so that exposure to traditional hazards are reduced in the long term. However, rapid economic development together with a lack of regulation can lead to two things. 1. First, it can impede the improvement in exposure to traditional environmental risks, such as from poor access to water and sanitation and poor access to clean energy. [[Insights]]: Relates to the existing idea that [[The deep causes of health inequity are not of a technical character, devoid of conflicting interests and power asymmetries, but tied to fairness and justice rather than biological variance]], particularly in environmental health. Making [[Environmental justice]] even more important. 2. Second, economic development has been associated with an increase in ‘modern’ environmental health risks, such as outdoor air pollution and chemical exposures from increased industrialization and modern agricultural practices, as well as traffic accidents from increasing use of road transport. These risks can increase before environmental management and other policies reduce the risks over time. [[Insights]]: [[Economic growth is necessary for development, but it is not sufficient]] — as growth comes with a different set of problems. ## Demographic transition Population dynamics have complex implications for public health, and three separate aspects need to be considered: • population growth; • population ageing; • population movement (temporary or permanent migration). > [!NOTE] Figure 3.3 shows the changes in mortality patterns in a rural area of Bangladesh. How have the environmental risks changed over time in this population? What are the likely driving forces of these environmental risks, and what is their impact on mortality? > 1. There is steep decline in the proportion of deaths from infectious (communicable) diseases. This is accompanied by an increase in the proportion of deaths from non-communicable diseases. The proportion of deaths from injuries and maternal causes has stayed relatively stable over time. > 2. Possible reasons for the decline in infectious diseases are likely to include: improvements in vector control; improved access to safe water and sanitation; increased immunization rates. > 3. The increase in incidence of non-communicable diseases is likely to be related to changes in diet and lifestyle. Increases in cancer incidence may perhaps be associated with past increases in tobacco smoking. On the other hand, fewer indoor cook stoves (and replacement with the use of clean energy) will have reduced the burden of mortality from acute respiratory infections. > 4. The likely upstream causes (driving forces) may include economic development leading to a change in diet, lower levels of physical activity and lifestyle factors including changes in smoking patterns and increased exposure to chemical hazards. ## The urban transition The concept of driving forces that influence health and the environment is particularly appropriate in the urban situation. The main driving force for urbanization is economic growth, particularly where manufacturing and services are the growth areas. Most large cities are in the world’s largest economies. Economic growth is reflected in structural changes to a nation’s economy; in growing economies the agricultural sector tends to decline, while the industry and services sectors (which are based in urban areas) tend to increase. One of the potential consequences of population influx into cities is that it may occur at a faster rate than the infrastructural development can cope with. This situation may lead to a lack of adequate services, such as water supply and sanitation, lack of good quality housing and a corresponding increase in inequality between the newcomers and the established inhabitants of the city. Within a rapidly urbanizing area, particularly in low-income countries, social and economic conditions are often uncoordinated or, as McMichael (2000) puts it, ‘Rapid urbanization represents a profound transformation . . . generally outstripping social and political responses’. ## Technological transitions [[technology has proved to be the best tool for capitalist structures to acquire hegemony over the total productive process by means of appropriating human identities, their preferences, and their perceptions of themselves]] While technology and innovation increase efficiency in agricultural and industrial production and improved health care, these developments are not all positive, as they also allow the development of inefficient technologies and the production of pollutants and waste products.