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Consequences and Options for Human Health Chapter 16 Consequences and Options for Human Health Coordinating Lead Authors: Carlos Corvalan, Simon Hales, Alistair Woodward Lead Authors: Diarmid Campbell-Lendrum, Kristie Ebi, Fernando De Avila Pires, Colin L. Soskolne Contributing Authors: Colin Butler, Andrew Githeko, Elisabet Lindgren, Margot Parkes Review Editors: Paul Epstein, Jorge Rabinovich, Philip Weinstein Main Messages . ............................................ 469 16.1 Introduction ........................................... 469 16.1.1 Overview of Health in the Context of Ecosystems 16.1.2 Impacts of Ecosystem Goods and Services on Health 16.1.3 Health in Scenarios 16.1.4 Typologies of Response Options and How They Apply to Health 16.2 Response Options and Actions outside the Health Sector ......... 476 16.2.1 Case Study: Climate Change, Land-use Changes, and Tick-borne Diseases—Illustrative Example from Sweden 16.2.2 Case Study: Responding to the Risk of Water-borne Campylobacteriosis 16.2.3 Case Study: Linking Ecosystems and Social Systems for Health and Sustainability—River Catchments 16.2.4 Case Study: Ciguatera (Fish Poisoning) and Ecological Change 16.3 Response Options and Actions by the Health Sector ............. 480 16.3.1 Improved Decision-making in the Health Sector 16.3.2 Methods for Measuring and Prioritizing Environmental Influences on Health 16.3.3 Methods for Selecting Interventions to Protect Health 16.3.4 Addressing Risk Perception and Communication 16.4 Cross-sectoral Response Options and Actions ................. 482 16.4.1 Health, Social Development, and Environmental Protection 16.4.2 Linking Health and Ecosystem Responses 16.5 Conclusion ........................................... 483 REFERENCES .............................................. 484 467 ................. 11430$ CH16 10-21-05 14:13:08 PS PAGE 467 468 Ecosystems and Human Well-being: Policy Responses BOXES 16.2 Causal Pathway from Driving Forces, through Exposures to 16.1 Disease Burden and Summary Measures of Population Health Outcomes, in the Context of Ecosystem Change Health 16.3 Potential Ecological Pathways in Fish Poisoning (Ciguatera) 16.2 Global Burden of Disease Attributable to Climate Change TABLES 16.3 Developments in Linking Disease to Environmental Factors 16.1. Relationships between Ecosystem Services and the Major 16.4 Examples of Responses to Improve Human Health Categories of Disease 16.2. Water and Sanitation-related Diseases FIGURES 16.3. Examples of Current and Future Vulnerability and Adaptation 16.1 Associations between Health, Other Aspects of Human Well- 16.4. Examples of Potential Health Implications of Sectoral being, and Ecosystem Services Responses ................. 11430$ CH16 10-21-05 14:13:08 PS PAGE 468 Consequences and Options for Human Health 469 Main Messages Where ill-health is caused, directly or indirectly, by excessive consump- tion of ecosystem services, substantial reductions in overconsumption Human health is both a product and a determinant of well-being. Mea- would have major health benefits while simultaneously reducing pres- sures to ensure ecological sustainability would safeguard ecosystem ser- sure on life-support systems (high confidence). Both human health and the vices and therefore benefit health in the long term (high confidence). In environment would benefit from a reduction in overconsumption. This would this chapter, health is the central concern, while noting the reciprocal relation- improve health in the short term as well as contribute to short-term ecological ships with other determinants of well-being. Negative health effects of ecosys- sustainability. Implementing better transportation practices and systems could tem disruption are already evident in many parts of the world. In the long term, lead to decreased injuries, increased physical activity in sedentary populations, some ecosystem change is inevitable. To limit the damage to human health as well as reduction in local air pollution and greenhouse gas emissions. Inte- caused by these changes, mitigation strategies that reduce the driving forces grating national agriculture and food security policies with the economic, social, of consumption, population increase, and inappropriate technology use are and environmental goals of sustainable development could be achieved, in needed. part, through ensuring that the environmental and social costs of production and consumption are more fully reflected in the price of food and water. Re- Ecosystem disruption damages health through complex pathways. Local duced consumption of animal products in rich countries would have benefits conditions exert a very strong influence on the nature, extent, and timing for human health and for ecosystems. of the effects on health. Social adaptations may minimize, displace, or postpone effects of ecosystem disruption on human health, but there are Society needs to balance technological and institutional development. To limits to what can be achieved. Human societies have developed methods achieve this balance, governments must incorporate environmental, social, and (such as agricultural systems or water supplies) that allow natural resources to health costs (both gains and losses) into measurements of progress. be appropriated for social benefit. Piped water supplies and other man-made resource appropriation systems provide human populations with a buffer in Approaches that perpetuate or worsen social inequalities may protect the times of environmental change. These social adaptations are usually designed health of privileged populations, but are likely to result in the worst to minimize local impacts. Many effects of ecosystem disruption on health are global health outcome overall. Globalization processes increasingly link the displaced, either geographically (such as the costs of rich countries’ overcon- health and well-being of privileged with poor populations. A selective approach sumption) or into the future (for example, long-term consequences of climate whereby the health and well-being of a small fraction of the global population is change or desertification). promoted at the expense of the majority entails a high risk for both populations. To understand the potential negative health impacts of ecosystem change, two aspects need to be considered: the current vulnerability of 16.1 Introduction the population affected and their future adaptive capacity. These two con- There are well-defined relationships between health and the other siderations are closely related, since vulnerable populations are less able to components of well-being as defined in the MA framework. Ma- plan and implement adaptive responses. Vulnerability and adaptive capacity terial lack, for example, is a strong determinant of health (and are also tied to other aspects of well-being (material minimum, freedom and indeed of other aspects of well-being). Both at the country level choice, social relations and security). and within countries, poorer communities have a worse health profile than richer ones. Among poor communities, women and Decisions about health and ecosystems must consider how one is re- children often bear the largest burdens of disease (WHO 2002). lated to the other. Choices that are made about the management of eco- At the global level, poorer countries are still battling traditional systems can have important consequences for health, and vice versa. hazards such as lack of clean water and sanitation, which contrib- Consideration of ecosystem change enlarges the scope of health responses ute considerably to the burden of disease in these countries. For by highlighting ‘‘upstream’’ causes of disease, injury, and premature death. example, the African region with 11% of the world’s population The health sector can make an important contribution to reducing the damage has over 50% of the world’s burden of disease resulting from in- caused by environmental disruptions, but the greatest gains will be made by fectious and parasitic diseases; in contrast, in the European region, interventions that are partly or wholly placed in other sectors. The health sector with 14% of the world’s population, the burden of disease in this bears responsibility for revealing the links and indicating which interventions category is less than 2% of the world’s total (based on WHO are needed. Decision-makers need to consider the connections between health regions, measured in ‘‘disability-adjusted life-years’’ (WHO and other sectors. Where there are trade-offs, it is important for politicians, 2002). (See Box 16.1.) regulators, and the public to understand the consequences of taking one path On the other hand, the lack of good health is a major determi- in preference to another. nant of poverty. For example, it is estimated that Africa’s GDP could have been $100 billion larger if malaria had been eliminated some 35 years ago (WHO 2000). GDP declines by about 1% Where a population is weighed down by disease related to poverty and when more than 20% of the population is infected with HIV lack of entitlement to essential resources such as shelter, nutritious food, (WHO 2002); see also reports of the Commission on Macroeco- or clean water, the provision of these resources should be the priority nomics and Health (WHO 2001). for healthy public policy (high confidence). The links between ecosystems Several studies have shown an important connection between and human health are seen most clearly among deprived communities, which social relations and health. People with good social networks live lack the ‘‘buffers’’ that the rich
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