Protecting people’s health through healthier environments requires bold political and collective action and systemic change, and public support – and it can only be done through regulatory frameworks that set clear standards and enforce compliance
Healthier environments could prevent a quarter of all deaths worldwide. Seven million deaths each year are due to air pollution, 800,000 deaths to unsafe water, sanitation and hygiene, and 2 million to selected chemicals. The largest health gains from creating healthier environments can be made in non-communicable diseases (notably cardiovascular diseases and chronic respiratory diseases), but also in several infectious diseases (such as diarrhoea and respiratory infections) and injuries. While the death rates from water, sanitation and hygiene, household air pollution due to unclean fuels and technologies and occupational risks are decreasing globally, the rate is increasing for ambient air pollution.
But there are the unknowns: these figures cover health impacts that can currently be quantified with reasonable (un)certainty. To a large extent, health impacts from climate change, biodiversity loss and most chemicals cannot yet be quantified. Yet these are the impacts that are rising, with climate change, biodiversity loss and use of chemicals progressing. We can even say they are potentially catastrophic if the next pathogen spilling over into humans is more devastating than the last one, and climate change takes a less optimistic path.
The World Health Organization has been actively advocating and supporting governments for healthier environments for healthier populations, through several streams of work:
Creating a demand for action through raising awareness, including with politicians and decision makers at all levels, stakeholder groups and communities;
Developing policy and technical guidance and tools and strengthening capacity for their implementation in countries in all sectors;
Fostering and supporting international agreements and commitments; and
Monitoring progress for better targeting of actions.
In the area of climate change, the WHO has been voicing health concerns at influential events such as the Conferences of the Parties to United Nations conventions, climate and health conferences and inter-ministerial dialogues, thereby bringing the issues to the attention of policymakers and other groups. It has been developing technical guidance and has supported health vulnerability and adaptation assessments, the health components of National Adaptation Plans, and the strengthening of climate resilience and the environmental sustainability of health systems and healthcare facilities. It facilitated countries’ commitment to develop climate resilient and low carbon sustainable health systems at COP26, and the Alliance for Transformative Action on Climate Change and Health is a WHO-led mechanism to support delivery of those commitments. And it has supported monitoring climate health hazards and the health sector response in countries to assist in targeting action. WHO work on other key environmental risks to health has been structured similarly.
Disease prevention through healthier environments has also been shown to be cost effective for health, even without counting the co-benefits from other, non-health areas. For example, reducing household air pollution by using cleaner fuels and technologies for cooking provides a 39% higher return on investment through avoiding direct health consequences, even before considering contributions to climate change with its complex consequences. Such prevention also means that suffering from ill health is avoided, and public or private expenditures for health care are saved.
Given the clear benefits of prevention through healthier environments, compared to treating ill health once it has happened, why does society not invest in it more?
There are several reasons. The tenure of politicians is shorter than some of the beneficial results accruing from putting policies into place and harvesting positive results on health – or at least shorter than the easily visible results. Powerful industries may resist regulations or invest heavily in lobbying to prevent government action. We need to ensure that we prioritise the health and well-being of citizens over profit. We cannot accept that the pockets of a few powerful industries outweigh the health of many uninfluential citizens. As long as people with vested interests participate in decision making, the result will not be driven by the public interest or people’s health. When looking at individual behaviour, a combination of perceived comfort, long-term consumption habits, and lack of awareness or understanding of the severity of the health consequences of pollution and climate change may also hamper change.
Also, questions may not always be asked in the right way.
Specific actions and policies could drastically reduce pollution, climate change and health impacts, yet no obvious action is taken. We should ask ourselves how many chemicals that we use daily are necessary or useful. Do we really need all these wrappings and cleaning products or could many of them easily be removed by changing habits and using alternative, more natural products? What about the unknown outcomes of microplastics and chemicals in our bodies when we (over)use consumer products for often only minor comfort? Why do we so easily accept the increasingly harmful effects of climate change, with its heatwaves, droughts, and impacts on food production and biodiversity without taking commensurate action? Similarly, why do we so easily accept chemicals that have been associated with male and female fertility dysfunction, hypertension, Parkinson’s disease and dementia?
Opportunities for long-lasting and impactful environmental policies and regulations are numerous and would bring about multiple short- and long-term benefits for people. This includes the enhanced development and use of renewable and sustainable energies, the replacement of harmful chemicals by alternative products, the reduction of single use plastics through packaging policies, the reduction of red meat consumption to minimal but healthy levels, equitable taxation and other measures to increase active and public transport, measures leading to reasonable and healthier consumption, or the use of local production where sound and feasible. And there are more steps that could end irrational policy choices and consumption patterns that result in a combination of pollution, health loss and climate change.
Protecting people’s health through healthier environments requires bold political and collective action and systemic change, and public support. Hoping for voluntary change at the individual level is not sufficient. Regulatory frameworks to set clear standards and guidelines, monitor and enforce compliance, and hold polluters accountable for any harm caused are needed. New governance mechanisms are required to reverse the degradation of planetary health and to protect populations. Many of the known solutions are win-win in terms of health gains, a healthier planet and costs to society, but do require decision making that is holistic and free of conflicts of interest.