# Session Overview Describe the development of environmental health approaches relevant to public health: · the rise of current environmental concerns · overview of various environmental approaches to public health with a focus on ecological public health Explain the basic requirements of a healthy environment and policy responses · Describe current and relevant international agreements · Introduce the Millennium Development Goals and the Sustainable Development Goals, as policy responses to environmental health challenges Describe the present speed, scale and impact of human-generated (anthropogenic) environmental change · Introduce the concept of planetary health and planetary boundaries · Introduce the concept of Anthropocene By the end of this session you should be able to: · describe the development of environmental health approaches relevant to public health · explain the basic requirements of a healthy environment and policy responses · understand the present speed, scale and impact of human-generated (anthropogenic) environmental change # 1. Introduction MDGs -> SDGs -> Anthropocene # 2. Brief overview of the evolution of environmental concerns for humans Environmental hazards can be natural or of anthropogenic. Some changes to the environment have been beneficial (improved housing, increased food production and water supply), some are harmful (air pollution from motorised traffic). Pollution, in the past, are limited to local environment and inhabitants due to the scale of human societies that were relatively small compared to today. History of public health: One way to understand some of the prominent changes to public health are as follows: 1. public health as health protection, mediated though societies’ social structures (antiquity – 1830s) 2. the shaping of a distinct public health discipline by the sanitary movement (“miasma control”, 1840s-1870s) 3. public health as contagion control (1880s-1930s) 4. public health as preventive medicine (1940s-60s) 5. public health as primary health care (1970s-1980s) 6. public health as health promotion (1990s-present) ## MDGs The eight goals were designed to require a commitment by HICs to relieve debt, increase aid and allow fair access to markets for the LMICs, and achieve targeted improvements in health. The responsibility for LMICs were to be accountable for their own actions and were expected to take the steps required to undertake ==policy reform==, and strengthen governance in order to achieve development. ## SDGs ==Overall, the SDGs are based on the triple bottom-line approach to human well-being, which covers environmental, social, and economic challenges== (GRI, 2015). Like the MDGs, the SDGs are not legally binding. Their purpose is to guide national and international jurisdictions, shape investment policies, adjust national and international data collection, as well as drive actions on sustainability issues until 2030 (GRI, 2015). ## Basic requirements for a healthy environment Physical, social, spiritual, economic and political dimensions of people's environments. Four main aspects: social, political, economic, and the empowerment of women. Supportive environments encompass such aspects as good social networks, democratic participation in decision making, sustainable economic development - including [[technology transfer]], the greater participation of women and recognition of their skills and knowledge. Current thinking on supportive environments has led to policy approaches such as the healthy setting environments - to maximize disease prevention via a "whole system" approach. As such, healthy settings can be [[healthy cities]], healthy workplaces, healthy schools, healthy homes. As the world population has increased, together with globalization, mass consumption and production, there has been growing acknowledgement that the present speed, scale and impact of human-generated (anthropogenic) environmental change (see Figure 3), far surpasses that of any past human activity (e.g. see for example Crutzen 2002; Steffen et al 2015a). Within this context, we are beginning to understand that improvements in human health are not only not independent of our environments, but also that they are potentially threatening the future human health. [[Planetary health]] is defined as the health of human civilisation and the state of the natural systems on which it depends' and a response to the discipline of public health's lack of engagement with global environmental change. Three categories of challenges to address improvements to human health, which they define as challenges of: 1. Imagination (conceptual or empathy failures): integrating sustainably sociocultural, economic and natural systems; develop approaches that engage simultaneously with biomedical, social, economic, and ecological approaches to health; and consider questions of resilience, scale of solutions and irreversible loss of natural capital 2. Research and information (or knowledge failures): increased inter- and trans-disciplinary research; integration of health and environmental measurements into surveillance systems; availability of funding; and knowledge translation 3. Governance (or implementation failures): delays in responding and dealing with threats; funding; accountability; inequities; and management of common pooled resources. # 3. Integrating activity Potential difficulties or limitations that the current concept of planetary health may exhibit? - Emphasize on human civilisation may obscure cultural diversity, inequalities and inequities - The ability of planetary health to avert anthropocentric styles of thinking and practice - If a population attains a given level of health or economic development by exploiting the environment unsustainably then it is likely to be doing so at the expense of other populations—now or in the future, or both. - Greater dialogue with scholars from social sciences and humanities, who have not only been critically engaging with the concept of Anthropocene and its implications for human, other species and earth, but also exploring how different societies understand, cope, and respond to ecological decline and human health. What do you think might be the opportunities that arise from the advent of the SDGs and the post-2015 development agenda on developing further the concept of planetary health? # 4. Summary # 5. References ## 5.1 [[Essential readings]] [[Hutchinson EJ]] and Kovats RS (2016) Environmental Health and Sustainable Development, Chapter 2. Assessing the impact of the environment on health. This chapter looks at how the environment affects human health. It also looks at the requirements for a healthy environment and the importance of environmental justice. [[Steffen W]], Richardson K, Rockström J, Cornell SE, Fetzer I, Bennett EM, Biggs R, Carpenter SR, de Vries W, de Wit CA, Folke C, Gerten D, Heinke J, Mace GM, Persson LM, Ramanathan V, Reyers B and Sörlin S (2015a) Planetary boundaries: Guiding human development on a changing planet. Science. 347 (6223): 1259855. Steffen et al discuss the planetary boundary framework and highlight the need to integrate the continued development of human societies and the maintenance of the Earth system in a resilient and accommodating state. ==They discuss how the planetary boundary framework can act as a vehicle to support decision making to promote sustainable development of countries and societies. However, the framework cannot be used as a means to indicate how countries or societies must develop. Policies and political decisions must take into account other factors, for example equity issues, that are not currently incorporated into the framework.== [[busecg]], Oestreicher JS, Ellis NR, Patrick R, Brisbois B, Jenkins AP, McKellar K, Kingsley J, Gislason M, Galway L, McFarlane RA Walker J, Frumkin H and Parkes H M (2018) Public health guide to field developments linking ecosystems, environments and health in the Anthropocene. J Epidemiol Community Health. 72 (5): 420-425. Buse et al provide an up-to-date overview of contemporary approaches relevant to public health professionals concerned with global environmental change. In addition, briefly outline each approach, they compare them to illustrate important differences, identifying the importance of their historical contingencies in shaping them. They also compare them, to demonstrate some of their similarities and synergies, which will be useful for those required to combine different approaches and engage with different practitioners. [[@whitmeeSafeguardingHumanHealth2015]] Focus on reading the following pages: 1-8 ('Executive summary' to where the Trends in global environmental change' section starts); 11-14 ('Non- linear changes and interactions between multiple environmental threats' O where the 'Key health effects of environmental change' section starts); and 46-47 ('Conclusions -policy propositions to advance planetary health". This paper is a report composed by The Rockefeller Foundation- Lancet Commission on planetary health, which is organised in part, as a response to the potential designation of the current geological Epoch as the Anthropocene. The authors provide an outline of what they mean by 'planetary health' and justifications for its invention. In doing so, they provide an extensive overview of environmental factors influencing human health, ecological degradation and their drivers, drawing on a large body of literature and some specific case studies. They identify three challenges (conceptual; knowledge and information; and implementation) to improving human health, in spite of potential increased risk from environmental degradation, and discuss various existing interventions and strategies, as well as relevant policies and governance issues. When reading the article, think about the challenges that health in the Anthropocene raise for global health policy? Does planetary health offer a convincing avenue to follow for uniting the pursuit of the future of human health together with the conditions that they are dependent on? What can Malm and Hornborg's (2014) paper add to the notion of planetary health? ## 5.2 [[Recommended reading]] Lawrence RJ, Forbat J, Zufferey J. Rethinking conceptual frameworks and models of health and natural environments. Health. 2019;23(2):158-179. do:10.1177/1363459318785717 Further exploration of ecological models Zhang X, Warner ME. Linking Urban Planning, Community Environment, and Physical Activity: A Socio-Ecological Approach. Int J Environ Res Public Health. 2023 Feb 8;20(4):2944.