Shanghai. Credit: Leniners/Flickr.

Environment + Public Health = The New Sustainability

HIV, malaria, heart disease, cancer, Alzheimer’s. When we think about health, we often think about such tragic diseases and how we can avoid them. These diseases have touched my life and the lives of many of you.

But there is another dimension to public health that is equally tragic, and one that has in the last few years also become a priority for scientific research and public policy: the impact of the environment on human health. For example: Did you know that more than 3.2 million people a year die from outdoor air pollution? The primary source of this pollution is production of commercial and residential energy — especially from coal (Jerrett 2015). The second biggest source is ammonia from livestock and fertilizers.

In other words, the same sources of greenhouse gases that are heating the planet are also killing millions of people in the short term.

Also: Did you know that diarrhea — which is widespread throughout the developing world due primarily to polluted water — kills 2.2 million people a year, most of them under five years old? That same untreated sewage flows to our oceans and may be a major factor in the loss of coral reefs.

And what about the pollutants that are making their way into our bodies, even in the developed world? A pioneering analysis sampled sewage sludge from 32 states and 94 different U.S. wastewater treatment facilities (Venkatesan & Halden 2014). The study found that our bodies contain massive loading of BFRs (brominated flame retardants — ubiquitous industrial chemicals). These compounds have been implicated as risk factors for the health of wildlife, fish and ourselves.

The study also found disturbingly high levels of antibiotics in the sludge. Now, antibiotics are not directly toxic to people — but resistance to antibiotics, which arises among pathogens as a result of evolution due to our overuse of antibiotics, claims 50,000 lives annually in Europe and the United States (the only places for which we have good data). If we keep using antibiotics for ourselves and our livestock at today’s levels, the World Health Organization predicts 10,000,000 deaths per year by 2050.

That mortality rate would represent more deaths than are caused by cancer and car accidents added together.

Health and the Environment: Three Reasons To Be Optimistic

I do not like doom and gloom blogs. And this has the feel of doom and gloom. So let’s lift our head out of the worst-case scenarios, and let in some fresh air and realistic optimism. What are the bright spots for environmental health?

First: Poll after poll shows that people care first and foremost about health. Emblematic species such as polar bears matter — but to be inspired by these magnificent animals, we have to be alive and healthy. Public health could well be the key that unlocks game-changing sustainable behavior and helps us to break the current logjam of climate inaction.

Second: People have never before had access to such good data — big data, personal data, and fine-scale monitoring data on pollution. Today, smart phone apps can allow us to see the air quality where we are and react accordingly. The tweeting of data from the US Embassy on air quality in Beijing played a major role in alerting the Chinese public to their air pollution crisis. Data can lead to awareness, and awareness to action.

Third: Global health foundations and organizations that traditionally have ignored the environment have woken up to the link between the environment and health, and are funding major new initiatives to do something about it.

Most notably, Wellcome Trust, one of the world’s largest funders of basic research, announced in September a new program labeled “Our Planet, Our Health”. This new program is designed to fund transdisciplinary research that connects environment and health. Such an initiative — and others like it — can’t come a moment too soon.

Why “Public Health Scientists” and “Environmentalists” Need To Move Past Silos

Environmentalists have had major successes such as the U.S. Clean Air and Clean Water Acts. Things were pretty dire when those successes were achieved: air quality in many U.S. cities was as poor as we now see in Beijing, and rivers were so polluted that they regularly caught on fire.

Today skies are bluer and waterways are generally not covered with oil slicks. But appearances can be deceiving. Many of the problematic air pollutants, such as ozone and fine particulates, are invisible. And the same goes for many of the toxins lurking in our waterways.

In some ways it’s easier to spur public action when things look bad. The challenge today, then, is to keep the public engaged and moving toward a cleaner healthier environment.

To do so, more environmentalists need to learn the language and statistical worldview of health professionals — including morbidity data and DALYs (Disability Adjusted Life Years, or the sum of years of potential life lost to premature mortality and the loss of productive life lost to disability).

I’m optimistic that such an analysis would spur people to better protect our forests and streams and rivers.

For their part, health experts need to awaken to the fact that ecological systems and evolutionary processes have critical bearing on water quality, resistance, and bioaccumulation of toxins up food chains.

And all of us need to realize that climate change is already a serious public health issue. Climate change is caused by pollutants that have direct health impacts, and ultimately will itself indirectly create a whole new suite of public health crises (exacerbated ozone, heat stress, floods, potential crop failures, drought, and so forth).

“Sustainability” has been so overused a word that its meaning has been cheapened. But when we assess the most recent research on the link between the environment and human health, it becomes obvious what the flesh and blood of sustainability is: connecting the dots of antibiotic resistance, how we grow our food, the health of our streams and rivers, where we get our energy, deforestation, air quality, and public health.


  • Darnerud, P.O. 2003. Toxic effects of BFR’s in man and in wildlife. Environment International 29:841–853.
  • Jerrett, M. 2015. The death toll from air-pollution sources. Nature 525: 330–331.
  • Salkeld, DJ, et al 2013. A meta-analysis suggesting that the relationship between biodiversity and risk of zoonotic pathogen transmission is idiosyncratic. Ecology Letters 16: 679–686/
  • Venkatesan, AK and R.U. Halden. 2014. Wastewater treatment plants as chemical observatories to forecast ecological and human health risks of manmade chemicals. Scientific Reports. DOI:10.1038/srep03731
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