COVID-19 and Planetary Health: How a Pandemic Could Pave the Way for a Green Recovery

STILL ONLY ONE EARTH: Lessons from 50 years of UN sustainable development policy

BRIEF #13 COVID-19 and Planetary Health: How a Pandemic Could Pave the Way for a Green Recovery

Nicole de Paula, Ph.D. Elizabeth Willetts March 2021

Key Messages and Recommendations

• The COVID-19 pandemic magnifies underlying systemic problems, including ineffective environmental policies, social and economic inequalities, and weak healthcare systems. • Policymakers need to strengthen climate resilience in our societies, economies, and ecosystems, and promote greater synergies and convergence between climate, biodiversity, and health finance. • Collaboration between environment and health ministries to form joint agendas and link policy and programming is essential to facilitate a green recovery. • International organizations and agencies need to break down silos, take joint action, and integrate policy and programming to promote planetary health.

Before the COVID-19 pandemic began in exposure can cost nearly USD 1 trillion in 2020, policymakers already faced sobering neurodevelopmental effects in middle and health statistics. As noted by the World Health low-income countries. Microplastics, nutrient Organization (WHO) and the United Nations excess from farm run-off, and zoonotic diseases Environment Programme (UNEP), nearly 25% impact health, well-being, and economic of all global deaths are related to economic development in overlapping and complicated decisions affecting the environment. Annually, 7 ways (Myers, 2017). million people die from poor air quality and 3.5 Existing environmental policies do not million die from poor water quality. Chemical effectively support global health and

sustainable development objectives. The COVID-19 pandemic has exacerbated these negative trends and has magnified underlying systemic problems, including social and economic inequality and weak healthcare systems. How can sustainable development policies cohesively and proactively address these interrelated challenges to improve human health?

Rethinking the Environment- Health Nexus The COVID-19 pandemic is the ultimate manifestation of an interconnected world. This Respiratory disease associated with air pollution is rampant, zoonotic virus, which jumps pathogenically especially in cities like New Delhi, India, where air quality has between wildlife and humans, reminds us of plummeted over the last few years. (Photo: iStock) the inter-relatedness of our molecular universe. The swift community lockdown in response health,” an emerging field that focuses on to the pandemic reminds us our existence how human-induced changes in our Earth’s depends on interwoven food and economic systems impact human health and well-being. pathways. Our neglect of these microscopic and macroscopic interlinkages between human The Effects of Environmental health and the environment is the root cause of the pandemic. Despite decades of scientific Change and Environmental warnings, we neglected the ecosystem factors Degradation on Health that promote infectious disease transmission. Worldwide, respiratory disease associated Human health in the Anthropocene requires with air pollution is rampant. There is a high an integrated approach. In 2015, the Lancet prevalence of chronic lung inflammation, medical journal in partnership with the increased acute asthma, and nasal and sinus Rockefeller Foundation published a landmark allergies, often requiring life-long medication. report alerting the medical community that According to the Lancet Commission on humans had damaged the Earth’s natural Pollution and Health, respiratory disease can systems to the point of causing reciprocal lead to lung cancers and diseases that affect risk and damage to human health. The report the heart, such as heart attack, stroke, high underlined the urgency and opportunity to blood pressure, and high cholesterol. Heart address modifiable environmental factors disease has been the leading cause of death to reduce the global burden of disease globally for two decades and is rising. and launched an international call for Diseases caused by water contamination world leaders and experts to support a continue to challenge clinicians, especially transdisciplinary approach called “planetary among marginalized and low-income

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populations, in post-disaster settings, access to green space has also been shown to and in communities in conflict. Without contribute to poor moods and sleep cycles. comprehensive water regulation, antibiotic It is worth noting the increase in the global treatment is a short-term solution to prevalence of depression disorders and their outbreaks of microbial diarrhea that stem correlation with both environmental change from ecosystem disruption in the form of and increasing social and economic inequality. biodiversity loss, excess nutrient run-off from Women and girls’ health and well-being are farms, or other human contamination. Viral impacted by environmental degradation and diseases arising from vectors living in water climate change. This is seen in increased ecosystems, like mosquitos, also strain health stress, higher rates of domestic violence, systems. Communities are grappling with reduced access to reproductive services increasing incidences of acute and chronic and contraception, and reduced access to hematological (Malaria), arthritic (Dengue, education and independent livelihoods. Chikungunya), or developmental (Zika) Moreover, the disproportionate number of disorders. These are exacerbated by climate women and girls affected by the COVID-19 change, which in turn can bring infected pandemic underscores the need to address the mosquitos to non-endemic and immune links between environment, gender inequality, system-naive countries. and poverty. Climate change is one of the greatest threats Food systems are paradoxically a threat to to public health (Haines & Ebi, 2019). Rising human health. According to the sixth Global temperatures, rising sea levels, and extreme Environmental Outlook, the agrifood system weather events pose increasing risks for human is inefficient, environmentally detrimental, and well-being (Watts et al., 2019), including poorly aligned with optimal nutritional needs. injuries, fatalities, mental health impacts, and Current food system production yields high mass migration (Andrews et al., 2018). emission goods, like animal protein and dairy Long-term environmental exposure to and products, and steers dietary habits toward accumulation of toxins, dioxins (persistent the overconsumption of low nutrition foods, organic pollutants), and endocrine disrupting like processed foods and snacks, which are chemicals in our bodies are, or are suspected cheaper and more accessible. As a result, both to be, linked to organ damage, cancer, developed and developing countries face a developmental and neurological disorders, and widespread combined burden of poor eating hormone dysfunction. (overeating or under) and micronutrient deficiency. The global incidence of diabetes Environmental degradation also affects the increased 70% in the last twenty years, and mental and emotional health and well-being clinics treat numerous obese patients taking of communities and individuals. Communities multiple chronic medications to regulate their may suffer forced displacement, contributing metabolism. The disruption caused by the to mental and emotional trauma. These COVID-19 pandemic led to the closure of events may additionally trigger psychological markets, decreased production and processing, illness seeded by underlying, long-standing, and restricted food transport including environmental injustice, health disparities, and imports, exports, and food assistance. These gender inequities. In urban settings, lack of

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simultaneous shocks have led to an estimated zoonoses and more than 75% of those are 80–130 million additional food insecure people. from wildlife.

Loss of biodiversity and ecosystem integrity weakens health systems and changes our International Recognition exposure to pathogens. At the community level, of the Environment-Health ecosystem degradation limits the availability Nexus of natural medicines and the sustainability of traditional knowledge, as well as opportunities The Stockholm Declaration and Action to identify new drugs to treat cancer, viral Plan adopted at the 1972 United Nations infections, neurological and brain disorders, Conference on the Human Environment and other elusive diseases. Antimicrobial was the first intergovernmental conference resistance, influenced by unregulated and non- outcome to recognize the right to a harmonized use of antimicrobial drugs across healthy environment. It further recognized the veterinary, livestock, and human health environmental disturbance and destruction sectors, threatens the long-term effectiveness as “harmful to the physical, mental and social of antimicrobial drugs and the ability to treat health of man.” The global conversation bacterial infections and diseases. Studies highlighted the need for integrated show biodiversity loss seems to increase environment and development policies at a emergence and exposure to new strains or number of major events: 1992 Earth Summit, new hosts of infectious disease (Myers, 2017). 1994 International Conference on Population Deforestation and manufactured waterways and Development, 1995 Fourth World (e.g., hydropower and irrigation systems) Conference on Women, 2000 UN Millennium may increase risk of exposure to more or Summit, and 2002 World Summit on new harmful microbes. Changes that lead Sustainable Development. However, practical humans to encroach on an ecosystem, such as engagement on the links between environment expanding agricultural land, bushmeat hunting, and health remained siloed. or legal and illegal wildlife trafficking increase In 2005, the Millennium Ecosystem human exposure to zoonotic diseases. This Assessment (MA) highlighted environmental includes coronaviruses (MERS, SARS and degradation as a significant barrier to COVID-19), HIV and Ebola, monkeypox virus, achieving the Millennium Development Goals and avian and swine influenza. The WHO and (MDGs), specifically addressing and reducing the Convention on Biological Diversity (2015) malnutrition, infectious diseases, maternal highlight the finding over a 68-year period mortality, exposure to unsafe drinking water, that 60% of emerging infectious diseases are and poverty. In its synthesis on human health, the MA outlined that ecosystems provide a number of services—provisioning, regulating, cultural, and supporting—whose “Ecosystem services are indispensable losses would adversely affect human health. to the well-being and health of people The MA recommended building capacity everywhere.” for low-income communities to adapt to environmental change. This would prevent a MILLENNIUM ECOSYSTEM ASSESSMENT

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Figure 1. The planetary health lens

Source: Myers, 2020. Reprinted with permission. downward health spiral where environmental COVID-19 and Planetary degradation begets poverty that generates further environmental degradation. Health: Mainstreaming and Mobilizing Green Recovery The current development paradigm—the 2030 Agenda for Sustainable Development Major international actors and agencies see and its Sustainable Development Goals planetary health as a “cross-cutting solution” (SDGs)—takes a step away from silos and (Figure 1) to achieve the SDGs and deliver on towards synergistic work, in part by providing the 2030 Agenda (UNEP, 2016; UNEP, 2019). interdisciplinary metrics to guide assessment The COVID-19 pandemic presents an and action. Trends in global engagement have opportunity to reconsider how we structure followed suit, as seen in the collaborations and integrate our food, waste, water, and between environmental fora, like the UN energy systems. It also means thinking about Framework Convention on Climate Change long-term health and well-being by evaluating (UNFCCC), Intergovernmental Panel co-benefits across environmental, social, and on Climate Change (IPCC), Convention economic domains. on Biological Diversity (CBD), and the Intergovernmental Platform on Biodiversity Innovative financing, built on cost-benefit and Ecosystem Services (IPBES), among analyses comparing health savings to the others, and in resolutions adopted by costs of mitigating environmental change the World Health Assembly (WHA) on and damage, is fundamental to this new environmental issues, including on climate, air paradigm (Myers, 2017; UNEP, 2019). For pollution, and antimicrobial resistance. instance, IPBES estimates the annual cost of zoonotic disease is in excess of USD 1 trillion, far higher than the USD 78-91 billion the Organisation for Economic Cooperation and

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Development (OECD) estimates for annual global biodiversity finance. Preventative actions, such as disease monitoring, retained forest cover, reductions in interspecies transmissions, and regulation of the wild meat trade, are estimated at USD 22-31 billion annually. This is significantly less than the mortality and economic costs of a pandemic like COVID-19, which is estimated at more than USD 8 trillion (Dobson et al., 2020). Similarly, health savings from policies that reduce air pollution are projected to be even greater, USD 23 trillion over the long term (UNEP, 2019). These data are compelling and warrant deeper examination, replication, and A COVID-19 testing site in Xochimilco, Mexico. (Photo: iStock) standardization across sectors. other global challenges. This view should COVID-19 resource mobilization can steer fully address climate change and the energy green recovery not only to “build back better” economy, the waste cycle, and food systems, but to take up long-held environmental with emphasis on ecosystems, biodiversity, sustainability and health evidence to effectively and social inclusion and equality. It should safeguard against future pandemics and also drive transformation in data collection, integration of sectors, and modes of engagement between international actors. Key priority areas are as follows. Socio-ecological determinants of zoonotic disease spread: Strengthen climate resilience in our • Land-use change economies and ecosystems and promote convergence between climate, biodiversity, • Human susceptibility to infection and health finance. Sustainable development • Agricultural industry change finance must include health co-benefits. • International travel and commerce Only 0.5% of multilateral climate finance • War and famine is earmarked specifically for health projects (WHO, 2018a). The WHO (2018b) notes • Medical industry change several specific barriers that present • Climate and weather opportunities for enhanced integration of • Demography and behavior health and climate policy, including: • Bushmeat • Only 10% of nationally determined • Breakdown of public health contributions funded by the Green • Food industry changes Climate Fund include health-related activities. (Loh et al., 2015)

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• The majority of national adaptation plans do not include health or specifically analyze the burden of climate-sensitive disease or prioritize health actions. • Health actors are not well connected to international climate change processes. • There is little formal engagement between the health and transportation sectors and health and energy sectors.

Move towards a resource-efficient circular economy and ecosystem-based approach.

Waste, in all its forms, is a serious health The current food system steers dietary habits toward the hazard and leads to disease. Policymakers need overconsumption of low nutrition foods, like processed to promote ambitious policies to reduce air, foods and snacks, which are cheaper and more accessible. land, soil, fresh water, and ocean pollution. An (Photo: iStock) emphasis on strengthening global coordination on marine litter and microplastics and support dietary guidelines to sustainability objectives for the Strategic Approach to International (UNEP, 2019). Chemicals Management (SAICM) to adopt Support and fund biodiversity and ambitious post-2020 recommendations ecosystem protection to prevent outbreaks are needed. Supply chains should focus of infectious diseases and strengthen on the life-cycle approach and not rely on nutritional security. Policymakers should environmentally harmful subsidies and other increase and improve sustainable land and perverse incentives. forest management to maintain genetic Steer food systems toward sustainability diversity and significantly reduce habitat loss, and improved food and nutritional unsustainable land-use change, deforestation, security. Under a business-as-usual scenario, and fragmentation. To prevent outbreaks of the way we produce and consume food infectious disease, policy measures should increases risks related to climate change, water promote conservation that reduces the insecurity, and malnutrition (CFS, 2021). transmission of pathogens, and strengthens Governments should support diversification in the resilience of human immune systems, such food system production while also redirecting as through controls on antimicrobial use and consumer food patterns, including promoting biocides. Biodiversity action plans and impact domestic food production and local food assessments should include health metrics and culture and knowledge. Linking environment adopt the One Health approach to monitoring. and health goals should reduce reliance on Both the CBD and the WHO call for improved high emission foods, assess both nutritional and integrated metrics to evaluate and monitor value and sustainability of consumption national biodiversity and health data. patterns, and connect national nutritional

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Reconfigure data metrics at all scales to and integrate policy and programming include interdisciplinary and overlapping within and among other multilateral risk factors. Policymakers should draw on organizations to promote planetary databases like the Global Burden of Disease health. The 2030 Agenda provides a global study that provides ongoing analyses of both blueprint for increased collaboration between health and environmental risk factors since international organizations, national and 1990. Policymakers should compare effects of sub-national governments, civil society, the different and combined risk factors, such as private sector, and other relevant stakeholders nutrition and zoonotic disease, on health and to ensure long-term policies are supportive use these in cost-benefit analyses. of planetary health. Environmental mandates must include health factors and global Promote broad multi-sectoral and health actors must realize their role in the transdisciplinary integration. Environment environmental community. The importance of and health ministries need to work together gender equity and environmental justice must and link policy and programming at all be recognized and brought to the forefront of scales. Finance ministers should work with discussion. medical leaders to design economic recovery packages that balance economic growth with human well-being and the environment Overcoming (WHO, 2020). Medical professionals should Multidimensional Crises and be encouraged to engage in environment Safeguarding against Future and sustainable development planning and policymaking. Health curricula should Pandemics incorporate environmental and sustainable COVID-19 has uncovered the gaps of development issues. Researchers must engage existing, fragmented policies and systems, in transdisciplinary approaches, incorporating, and has made it impossible to ignore the for example, traditional knowledge. potential repercussions of future health and International organizations and agencies environmental decisions. At the same time, need to break down silos, take joint action, it has created a platform for comprehensive social, economic, and environmental change. Sustainable and equitable development requires integrated approaches. Effective “Decisions made in the coming policies must be cross-cutting and months can either ‘lock in’ economic intersectional rather than isolated actions development patterns that will do or singular technological improvements. Implementing green recovery approaches will permanent and escalating damage to create multiplier effects, including on health, the ecological systems that sustain gender and social equity, and economics. all human health and livelihoods, or, if COVID-19 can be an opportunity to use wisely taken, can promote a healthier, planetary health as a new guiding development fairer, and greener world.” narrative. Health and environment should be considered as one and become eligible for joint WORLD HEALTH ORGANIZATION

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funding opportunities. Examples of funders Moore Foundation. More than the exception, championing this recommendation include synergies between environmental and health the Wellcome Trust and the Gordon and Betty policies must be the rule.

Works Consulted Andrews, O., Le Quéré, C., Kjellstrom, Haines, A. & Ebi. K. (2019). The Imperative T., Lemke, B., & Haines, A. (2018). for Climate Action to Protect Health, The Implications for workability and New England Journal of Medicine, 380: 263- survivability in populations exposed to 273 https://www.nejm.org/doi/full/10.1056/ extreme heat under climate change: A nejmra1807873 modelling study. The Lancet Planetary Myers, S. (2017). Planetary health: Protecting Health, 2(12), e540–e547. https://doi. human health on a rapidly changing org/10.1016/s2542-5196(18)30240-7 planet. The Lancet. 390 (10114): 2860- Committee on World Food Security (CFS). 2868. https://doi.org/10.1016/S0140- (2020). Impacts of COVID-19 on food 6736(17)32846-5 security and nutrition: Developing effective Myers. S. (2020). An Introduction to Planetary policy responses to address the hunger Health. In Planetary Health: Protecting and malnutrition pandemic. CFS High- Nature to Protect Ourselves. Island Press. Level Panel of Experts on Food Security and Nutrition Issues Paper. Food and Agriculture Loh, E. H., Zambrana-Torrelio, C., Olival, K. Organization of the UN. http://www.fao. J., Bogich, T. L., Johnson, C. K., Mazet, org/3/cb1000en/cb1000en.pdf J. A. K., Karesh, W., & Daszak, P. (2015). Targeting transmission pathways for CFS. (2021). CFS Voluntary Guidelines on emerging zoonotic disease surveillance and Food Systems and Nutrition. Food and control. Vector-Borne and Zoonotic Diseases, Agriculture Organization of the UN. 15(7): 432–437. https://doi.org/10.1089/ http://www.fao.org/fileadmin/templates/ vbz.2013.1563 cfs/Docs1920/Nutrition_Food_System/ Negotiations/NE_982_47_8_VGFSYN.pdf UNEP. (2016). Healthy environment, healthy people. https://wedocs.unep.org/ de Paula, N. & Mar, K.A. (2020). Moving bitstream/handle/20.500.11822/17602/ as One. Integrating the Health and K1602727%20INF%205%20Eng.pdf Climate Agendas for Planetary Health in a Post-Pandemic World. IASS Policy UNEP. (2019). Global Environment Brief, 2/2020. https://doi.org/10.2312/ Outlook – GEO-6: Healthy planet, healthy iass.2020.025 people. United Nations Environment Programme. https://wedocs.unep.org/ Dobson, A., Pimm, S., Hannah, L., Kaufman, handle/20.500.11822/27539 L., Ahumada, J., Ando, A., . . . Vale, M. (2020, July 24). Ecology and economics for pandemic prevention. Science 369 (6502): 379-381. https://science.sciencemag.org/ content/369/6502/379

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The Still Only One Earth policy brief series is published with the support of the Swedish Ministry of Environment, the Norwegian Ministry of Climate and Environment, and Global Affairs Canada. The editor is Pamela Chasek, Ph.D. The opinions expressed in this brief are those of the authors and do not necessarily reflect the views of IISD or other donors.

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