Connecting Global Priorities: Biodiversity and Human Health

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Connecting Global Priorities: Biodiversity and Human Health Summary of the State of Knowledge Review

Secretariat of the Convention on Biological Diversity Department of Public Health, Environmental World Trade Centre and Social Determinants of Health (PHE) 413 St. Jacques Street, Suite 800 World Health Organization (WHO) Montreal, Quebec, Canada H2Y 1N9 Avenue Appia 20 – CH-1211 Geneva 27 – Switzerland Phone: 1 (514) 288 2220 www.who.int/phe/en/ Fax: 1 (514) 288 6588 ISBN 978 92 4 150853 7 E-mail: [email protected] Website: http://www.cbd.int

The State of Knowledge Review

Connecting Global Priorities: Biodiversity and Human Health

Summary of the State of Knowledge Review WHO Library Cataloguing-in-Publication Data Climate change, biodiversity and human health I.World Health Organization. ISBN 978 92 4 150853 7 Subject headings are available from WHO institutional repository All rights reserved. Publications of the World Health Organization are available on the WHO web site (www.who.int) or can be purchased from WHO Press, World Health Organization, 20 Avenue Appia, 1211 Geneva 27, Switzerland (tel.: +41 22 791 3264; fax: +41 22 791 4857; e-mail: [email protected]). Published by the World Health Organization and the Secretariat of the Convention on Biological Diversity © World Health Organization and Secretariat of the Convention on Biological Diversity, 2015. The designations employed and the presentation of the material in this publication do not imply the expression of any opinion whatsoever on the part of the World Health Organization nor on the part of the Secretariat of the Convention on Biological Diversity concerning the legal status of any country, territory, city or area or of its authorities, or concerning the delimitation of its frontiers or boundaries. Dotted and dashed lines on maps represent approximate border lines for which there may not yet be full agreement. Detailed information about maps, such as on data source, map production and copyright, will be provided in endnotes at the end of the publication. The mention of specific companies or of certain manufacturers’ products does not imply that they are endorsed or recommended by the World Health Organization nor Secretariat of the Convention on Biological Diversity in preference to others of a similar nature that are not mentioned. Errors and omissions excepted, the names of proprietary products are distinguished by initial capital letters. All reasonable precautions have been taken by the World Health Organization and the Secretariat of the Convention on Biological Diversity to verify the information contained in this publication. However, the published material is being distributed without warranty of any kind, either expressed or implied. The responsibility for the interpretation and use of the material lies with the reader. In no event shall the World Health Organization nor the Secretariat of the Convention on Biological Diversity be liable for damages arising from its use. Cover photo credits: (left to right) 1st row i) iStockphoto/pailoolom ii) Conor Kretsch iii) Glen Bowes 2nd row i) Danny Hunter ii) Bioversity International iii) A.Camacho 3rd row i) Glen Bowes ii) Jon Betz / NGS iii) Barry Kretsch 4th row i) iStockphoto/ rssfhs ii) iStockphoto iii) Ecohealth Alliance Produced by Inís Communication (www.iniscommunication.com)

For further information, please contact: Secretariat of the Convention on Biological Diversity Department of Public Health, Environmental and World Trade Centre Social Determinants of Health (PHE) 413 St. Jacques Street, Suite 800 Montreal, Quebec, World Health Organization (WHO) Canada H2Y 1N9 Avenue Appia 20 – CH-1211 Geneva 27 – Switzerland E-mail: [email protected] www.who.int/phe/en/ www.cbd.int/health

Connecting Global Priorities: Biodiversity and Human Health, a State of Knowledge Review is published by the Secretariat of the Convention on Biological Diversity and the World Health Organization and has been prepared in close collaboration with numerous partner organizations and experts that have generously contributed their time, energy and expertise to the preparation of the volume. The lead coordinating authors are Cristina Romanelli, David Cooper, Diarmid Campbell-Lendrum, Marina Maiero, William B. Karesh, Danny Hunter and Christopher D. Golden. This summary was prepared by the lead coordinating authors in consultation with numerous lead authors and contributors to the full volume. For the complete list of acknowledgments and references please see the full volume. The production of Connecting Global Priorities: Biodiversity and Human Health, a State of Knowledge Review was enabled through financial contributions from the European Commission and the Government of France, as well as the in-kind contributions of partners. Logo (horizontal) Positive versions

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13 CONOR KRETSCH Braulio Ferreira Dias de Souza Diversity Foreword Convention of the by Secretary on Executive Biological the Forewords Executive Secretary, Convention on Biological Diversity Assistant Secretary General the United Nations of Secretary Secretary,Executive Assistant Diversity Convention on Biological coordinated that solutions jointlyreduce threats to develop coherent robust, equipped better and healthwe and development, become global loss, biodiversity, between links the vital of persistent its science continues toAs unravel ourunderstanding forour common development. agenda sustainable people”. essential forThey all are centralbenefits to a healthy and sustaining delivering planet services, restored maintaining ecosystem used, and wisely is valued,2050 Vision: conserved, “Biodiversity for Plan Biodiversity,Strategic and reflected its in healthhuman are entrenched deeply inthe andecosystems, the provision benefits these of inexorable biodiversity, between The links and noncommunicable diseases. confrontto stemof infectioustide the ourefforts that puzzle epidemiological the of component and each animportant our health and well-being, directfunctions has and indirect consequences for climate change and natural disasters. these Each of to that and disease of pests of the regulation functions that range fromcritical and perform contribute to the provision clean water of and air, also They enrichment. and cultural and spiritual fuel, energy, compounds, medicinal livelihoods and medicines nutrients, foodof and essential including life. human arethe planet, They sources that deliver they are central pillarsfor alllife on Biodiversity, services ecosystems and the essential Connecting Global Priorities: Biodiversity andHuman Health not compound but rathernot help to face the public biodiversity, of name sectors health ordo other We made inthe ensure must that interventions generously this to to fruition. contributed bring who and experts and allpartners Organization grateful to the WorldI amespecially Health step inthis direction.review isaconstructive state knowledge of This services. supporting the forces to deliver their that ability life- impede ecosystemstrengthening resilience and mitigating tous develop of capable effective solutions influences whichby are they mediated, enables complexthese relationships andat the all scales, of Increasing ourknowledge it. that sustains to life human and to environment the surrounding sustainable, agenda in2015and beyond. agenda sustainable, pave the road toward amore and truly equitable, threats that we face. inthis way Only canwe truly to common the common solutions of development alike – contributeto can –and must thecitizens educators,makers, communities scientists, and present and future policy- generations. sectors, All the of growing needs meeting capable of planet a healthier,in the of pursuit more sustainable We habitats. peri-urban are allstakeholders and urbanand zones into intensive agricultural the transformation once of natural landscapes pressures,socio-demographic travel, trade and by rising challenges posed health and conservation iii Foreword by the Director, Public Health, Environmental and Social Determinants of Health, World Health Organization

At WHO, we are aware of the growing body of epidemic infectious diseases such as the Ebola evidence that biodiversity loss is happening virus; and the connection between biodiversity, at unprecedented rates. There is increasing nutritional diversity and health. It also covers recognition that this is a fundamental risk to the the potential benefits of closer partnerships healthy and stable ecosystems that sustain all between conservation and health, from improved aspects of our societies. surveillance of infectious diseases in wildlife and human populations, to promoting access to green Human health is not immune from this threat. All spaces to promote physical activity and mental aspects of human wellbeing depend on ecosystem health. Of course, it also highlights the many areas goods and services, which in turn depend on in which further research is needed. biodiversity. Biodiversity loss can destabilize ecosystems, promote outbreaks of infectious We hope this joint report will be able to help disease, and undermine development progress, policy makers to recognize the intrinsic value of nutrition security and protection from natural biodiversity and its role as a critical foundation disasters. for sustainable development and human health and well-being. Protecting public health from these risks lies outside of the traditional roles of the health In particular, we hope the report provides a useful sector. It relies on working with partners engaged reference for the Sustainable Development Goals in conservation, and the sustainable use and and post-2015 development agenda, which management of natural resources. represents an unique opportunity to promote integrated approaches to biodiversity and health In this regard, WHO appreciates the leadership by highlighting that biodiversity contributes that the Secretariat of the Convention on to human well-being, and highlighting that Biological Diversity has shown in promoting the biodiversity needs protection for development to linkages between biodiversity and health. be sustainable.

The report synthesizes the available information WHO looks forward to working jointly with our on the most important inter-linkages; for example CBD colleagues, and the wider conservation between biodiversity, ecosystem stability, and community, to support this important agenda.

Dr. Maria Neira Director, Public Health, Environmental and Social Determinants of Health, World Health Organization

iv Connecting Global Priorities: Biodiversity and Human Health GLEN BOWES on Planetary Health on Planetary Preface by Chair the of Rockefeller The Commission Foundation-Lancet Preface and Professor of Primary Care at the London School of Hygiene and Tropical Care Hygiene of School at the Medicine London and Professor Primary of Health andProfessor Publicof Planetary Health Commission The Rockefeller on of Chair Foundation-Lancet Professor Andy Sir Haines of actions to and the benefits reduce them. in ourunderstanding risks these of understand, and respond that to we ourselves the risks have created advance and is athis major Review to Health interpret, isto civilisations, human of develop the capability over the coming century Planetary and the World Diversity greateston Biological The Health Organization. challenge to protecting from Review the ConventionStateKnowledge of The Commission welcomestimely and important this Lancet inJuly2015. inThe apeer-reviewed Commissionof Report since publication will the July2014,and concludeits work through underway been The Commissionhas insectors working that influence health, developmentcommunity and policymakers and the biosphere. out set Health) and recommendations for action to the Planetary healthsystems (The Commission on Earth’sof to review basis natural the scientific human health for linking to integrity the underlying Lancet, have a Commission toIn response The Rockefeller challenges, these formed and The Foundation and prosperity. wherebuild apost-2015 ahealthy agenda aprecondition as biosphere for isrecognised health human relationships across researchdisciplinary themes are challenges key addressed, which be must to help environment and building inter- and communicating co-benefits of and health, identifying examples the biosphereboth reach. andhealth human lie within Improving between links the evidenceof base forcause hope.The interconnected nature mean thatsolutions thatbenefit andpeople the planet of likelyand will become the dominant threat to century. health over the next there But much isalso unchecked changes these threatenLeft to reverse several health the gainslast of the decades global and loss; biodiversity pollution, havedegradation, to already negatively impact health. human begun systems; including accelerating growing water degradation, land scarcity, climatic disruption, fisheries to systems. Theof transformations impacts the and Earth’s biogeochemical to these ecological however,has, conventionalextensive Thishuman flourishing degradation been at the of cost metrics. 50 last The yearshave unprecedentedseen improvements inhuman health,as measured by most Connecting Global Priorities: Biodiversity andHuman Health v Biodiversity and human health

Nutrition Agricultural Disaster risk Health “is a state of biodiversity Direct drivers of complete physical, mental biodiversity loss include Air quality and social well-being and land-use change, habitat loss, not merely the absence of over-exploitation, pollution, disease or inﬁrmity”. invasive species and climate change. Many of these drivers Water quality aﬀect human health directly Mental health and through their impacts on biodiversity.

Biological diversity Food & Water (biodiversity) is “the variability security Climate among living organisms from change all sources including, inter Women and men alia, terrestrial, marine and have diﬀerent roles in the other aquatic ecosystems and conservation and use of the ecological complexes of biodiversity and varying which they are part; this health impacts. includes diversity within Sustainable Health species, between species and development outcomes of ecosystems.” Microbial biodiversity

Biomedical/ Ecosystems Human population pharmaceutical health is determined, to a Biodiversity discovery large extent, by social, eco- underpins ecosystem nomic and environmental functioning and the provision factors. of goods and services that are essential to human health and Traditional Infectious well being. medicine diseases

The social and natural sciences are The links between important contributors to biodiversity and health biodiversity and research and policy. Integra- health are manifested at tive approaches such as the various spatial and temporal Biodiversity Ecosystem Approach, Eco- scales. Biodiversity and health and One Health unite human health, and the diﬀerent ﬁelds and require respective policies and the development of mutual activities, are interlinked in understanding and coopera- various ways. tion across disciplines. Biodiversity and human health

Executive Summary

GLEN BOWES Executive Summary

INTRODUCTION health and well-being. Ecosystems, including our food production systems, depend on a 1. Health “is a state of complete physical, whole host of organisms: primary producers, mental and social well-being and not herbivores, carnivores, decomposers, merely the absence of disease or infirmity”. pollinators, pathogens, natural enemies This is the definition of health by the World of pests. Services provided by ecosystems Health Organization. Health status has include food, clean air, and both the quantity important social, economic, behavioural and quality of fresh water, medicines, and environmental determinants, and wide- spiritual and cultural values, climate ranging impacts. Typically, health has been regulation, pest and disease regulation, and viewed largely in a human-only context. disaster risk reduction. Biodiversity is a key However, there is increasing recognition of environmental determinant of human health; a broader health concept that encompasses the conservation and the sustainable use of other species, our ecosystems and the integral biodiversity can benefit human health by ecological underpinnings of many drivers or maintaining ecosystem services and options protectors of health risks. for the future.

2. Biological diversity (biodiversity) is “the 4. The links between biodiversity and variability among living organisms from health are manifested at various spatial all sources including, inter alia, terrestrial, and temporal scales. At a planetary scale, marine and other aquatic ecosystems and ecosystems and biodiversity play a critical role the ecological complexes of which they are in determining the state of the Earth System, part; this includes diversity within species, regulating its material and energy flows, and between species and of ecosystems”. its responses to abrupt and gradual change. At This definition of the Convention on a more intimate level, the human microbiota – Biological Diversity (Article 2) reflects the symbiotic microbial communities present different levels of biodiversity (including on our gut, skin, respiratory and urogenital genetic diversity, species and ecosystems), tracts, contribute to our nutrition, can help and the complexities of biotic and abiotic regulate our immune system and prevent interactions. The attributes and interactions infections. of biotic and abiotic components determine ecosystem processes and their properties. The 5. Biodiversity and human health, and effective management of ecosystems as part the respective policies and activities, of comprehensive public health measures are interlinked in various ways. First, requires that these various complex linkages biodiversity gives rise to health benefits. For and interactions be identified and understood. example, a variety of species and genotypes provide nutrients and medicines. Biodiversity 3. Biodiversity underpins ecosystem also underpins ecosystem functioning, which functioning and the provision of goods provides services such as water and air and services that are essential to human

Connecting Global Priorities: Biodiversity and Human Health 1 purification, pest and disease control, and 7. Human population health is determined, pollination. However, it can also be a source to a large extent, by social, economic and of pathogens, leading to negative health environmental factors. Social determinants outcomes. A second type of interaction of health include poverty, gender, sex, age, and arises from drivers of change that affect both rural versus urban areas. Vulnerable people biodiversity and health in parallel. For example, and groups (such as women and the poor) who air and water pollution can lead to biodiversity tend to be more reliant on biodiversity and loss and have direct impacts on health. A third ecosystem services suffer disproportionately type of interaction arises from the impacts of from biodiversity loss and have less access to health sector interventions on biodiversity social protection mechanisms (for example, and of biodiversity-related interventions access to health care). A social justice on human health. For example, the use of perspective is needed to address the various pharmaceuticals may lead to the release of dimensions of equity in the biodiversity and active ingredients in the environment and health dynamic. Vulnerability and adaptation damage species and ecosystems, which in turn assessments are needed and should be tailored may have negative knock-on effects on human to the contexts of these populations. health. Protected areas or hunting bans could deny access of local communities to bushmeat 8. Women and men have different roles in the and other wild sources of food and medicines conservation and use of biodiversity and with negative impacts on health. Positive experience gender-differentiated health interactions of this type are also possible; impacts. Access to, use and management for example, the establishment of protected of biodiversity has differential gender health areas may protect water supplies with positive impacts, shaped by respective cultural health benefits. values and norms, which in turn determine roles, responsibilities, obligations, benefits 6. Direct drivers of biodiversity loss and rights. Institutional capacity and legal include land-use change, habitat loss, frameworks often inadequately reflect overexploitation, pollution, invasive differential gender roles. There is also a lack species and climate change. Many of these of gender-disaggregated data on biodiversity drivers affect human health directly and access, use and control, and on the differential through their impacts on biodiversity. The health impacts of biodiversity change. continued decline of biodiversity, including loss or degradation of ecosystems, is reducing 9. The social and natural sciences are the ability of biodiversity and ecosystems to important contributors to biodiversity provide essential life-sustaining services and, and health research and policy. Integrative in many cases, leads to negative outcomes for approaches, such as the ecosystem health and well-being. Ecosystem degradation approach, ecohealth and OneHealth, may lead to both biodiversity loss and unite different fields and require the increased risk from infectious diseases. In development of mutual understanding and turn, the indirect drivers of biodiversity loss cooperation across disciplines. are demographic change and large-scale social and economic processes. Social change and Multidisciplinary research and approaches can development trends (such as urbanization), provide valuable insights into the drivers of poverty and gender also influence these disease emergence and spread, contribute to drivers of change. Macro-economic policies identifying previous patterns of disease risk, and structures, and public policies that provide and help predict future risks through the lens perverse incentives or fail to incorporate the of social–ecological systems. Such challenges value of biodiversity often compound the dual necessitate engagement of many stakeholders, threat to biodiversity and public health. including governments, civil society,

2 Connecting Global Priorities: Biodiversity and Human Health and nongovernmental and international erosion. Many ecosystems can also play a role organizations. Integrative approaches such in managing pollution; the water purification as these make it possible to maximize services they provide underpin water quality. resource efficiency as well as conservation, Mountain ecosystems are of particular health and development outcomes. While significance in this regard. Many protected their value is increasingly recognized for areas are established primarily to protect water infectious disease prevention and control, supplies for people. their wider applications and benefits can also extend to other areas, e.g. to the assessment 11. Freshwater ecosystems, such as rivers, of environmental health exposures and lakes and wetlands, face disproportionately outcomes, better understanding of the health high levels of threat due largely to demands services provided by biodiversity, and of how on water and impacts of human activities anthropogenic changes to an ecosystem or such as dam construction and mining. In biodiversity may influence disease risks. some regions, up to 95% of wetlands have been lost and two thirds of the world’s largest rivers are now moderately to severely fragmented WATER, AIR QUALITY AND HEALTH by dams and reservoirs. Freshwater species have declined at a faster rate than any other biome, with the sharpest decline in tropical freshwater biomes. More than one third of the accessible renewable freshwater on earth is consumptively used for agriculture, industrial and domestic use, which often leads to chemical pollution of natural water sources. Other human activity, such as mining, can also lead to bioaccumulation and biomagnification.

12. Impaired water quality results in significant social and economic costs. Ecosystem degradation – for example, through eutrophication caused by excessive nutrients – is a major cause of decline in water quality. Left untreated, poor-quality water results in massive burdens on human health, with the ERIC SALES / ASIAN DEVELOPMENT BANK FLICKR most pronounced impacts on women, children Access to clean water is fundamental to human and the poor. Maintaining or restoring healthy health and a priority for sustainable development. ecosystems (for example, through protected Yet, almost 1 billion people lack access to safe areas) is a cost–effective and sustainable way drinking water and 2 million annual deaths are to improve water quality while also benefiting attributable to unsafe water, sanitation and biodiversity. hygiene. Biodiversity and ecosystems play a major role in regulating the quantity and quality of water 13. Water-related infrastructure has positive supply but are themselves degraded by pollution. and negative impacts on biodiversity, livelihoods and human health. Altered 10. Ecosystems provide clean water that waterways (e.g. dams, irrigation canals, underpins many aspects of human health. urban drainage systems) can provide valuable All terrestrial and freshwater ecosystems benefits to human communities, but may be play a role in underpinning the water cycle, costly to build and maintain and, in some including regulating nutrient cycling and soil cases, increase risks (e.g. flood risk from coastal

Connecting Global Priorities: Biodiversity and Human Health 3 wetlands degradation). They can also diminish pollen, sometimes associated with acute native biodiversity and sometimes increase respiratory problems. Burning of vegetation the incidence of waterborne or water-related is also associated with significant pollution illnesses such as schistosomiasis. Approaches emissions. integrating the benefits of both physical/built and natural infrastructure can provide more 15. Components of biodiversity can be sustainable and cost–effective solutions. used as bioindicators of known human health stressors, as well as in air- and water-quality mapping, monitoring and regulation. Lichens are among the most widely utilized and well-developed indicators of air quality to date, and are making headway as reliable indicators for air quality regulation. The shift in species is predictable and often correlates highly with deposition measures, making lichens an accurate, cost–effective tool for mapping and monitoring. Other groups of UNDP BANGLADESH / FLICKR organisms with high local biological diversity Air pollution is one of the most significant (e.g. insects and other arthropods) have high environmental health risks worldwide, responsible potential as bioindicators because they have for seven million deaths in 2012. Bronchial asthma the capacity to provide more fine-grained and chronic obstructive pulmonary disease are on information about the state of ecosystems; the rise. Cardiovascular disease, immune disorders, they are also relatively easy to survey. Water various cancers, and disorders of the eye, ear, nose quality can be monitored through chemical and throat are also affected by air pollution. Air analysis but long-term trends in freshwater pollution also affects biodiversity; it can reduce plant ecosystems are perhaps better monitored biodiversity and affect other ecosystem services, using the diversity of aquatic organisms (e.g. such as clean water and carbon storage. benthic invertebrates) as proxy for water quality and ecosystem health. 14. Ecosystems may affect air quality and have primarily beneficial outcomes for human health. Ecosystems affect air quality in three main ways: (1) Deposition – ecosystems directly remove air pollution, through absorption or intake of gases through leaves, and through direct deposition of particulate matter on plant surfaces. (2) Changes in meteorological patterns – as ecosystems affect local temperature, precipitation, air flows, etc., they also affect air quality and pollutant emissions. By altering climate and shading buildings, ecosystems in cities alter energy use and consequent greenhouse gas emissions. (3) Emissions – many ecosystems emit volatile organic carbons (VOCs), including terpenes and arenes. While sometimes considered as pollutants, many natural VOCs play a critical role in atmospheric chemistry and air- quality regulation. Ecosystems also release

4 Connecting Global Priorities: Biodiversity and Human Health BIODIVERSITY, FOOD control, nutrient cycling, erosion control and PRODUCTION AND NUTRITION water supply. 17. The loss of diversity from agroecosystems is increasing the vulnerability and reducing the sustainability of many production systems, and has had negative effects on human health. While there have been significant increases in food production through the introduction of higher-yielding uniform varieties and breeds, loss of genetic diversity in production systems through monocropping of uniform crop varieties or animal breeds has led to instances of large production losses and, in some cases, has had significantly negative health consequences. Loss of diversity has also resulted in the reduced provision of regulating and supporting ecosystem services, requiring additional chemical inputs and creating negative feedback loops.

18. The use of chemical inputs, particularly BIOVERSITY pesticides, has had severe negative Agricultural productivity has increased substantially consequences for wildlife, human health over the past 50 years, yet some 800 million people and agricultural biodiversity. While the are food insecure. It is estimated that by 2050, food control of disease vectors such as malaria production will have to feed over 9 billion people, has generated health benefits, the use of many of whom will be wealthier and demand more pesticides, especially in agriculture, has led food with proportionately more meat and dairy to serious environmental pollution, affected products that have greater ecological footprints. human health (25 million people per year suffer from acute pesticide poisoning in Biodiversity underpins the productivity and developing countries), and caused the death resilience of agricultural and other ecosystems. of many non-target animals, plants and fish. However, land-use change and agriculture are The use of agricultural biodiversity to help dominant causes of biodiversity loss. cope with pests and diseases and to improve soil quality is a win–win option that produces 16. Biodiversity in and around agricultural benefits to human health and to biodiversity. production systems makes essential contributions to food security and health. 19. Pollination is essential to food security Biodiversity is the source of the components generally and to the production of many of production (crops, livestock, farmed fish), of the most nutritious foods in particular. and the genetic diversity within these that Pollinators play a significant role in the ensures continuing improvement in food production of approximately one third of the production, allows adaptation to current global food supply. Pollination also affects needs and ensures adaptability to future ones. the quantity, nutritional content, quality and Agricultural biodiversity is also essential for variety of foods available. Global declines in agricultural production systems, underpinning pollinator species diversity and in the number ecosystem services such as pollination, pest of pollinators have critical implications for

Connecting Global Priorities: Biodiversity and Human Health 5 food security, agricultural productivity and, Malnutrition is the single largest contributor to the potentially, human nutrition. global burden of disease, affecting citizens of every country in the world, from the least developed to the 20. Increasing sustainable production and most. Two billion people are estimated to be deﬁcient meeting the challenges associated with in one or more micronutrients. At the same time, climate change will require the increased the consumption of poor-quality processed foods, use of agricultural biodiversity. Climate together with low physical activity, has contributed change is already having an impact on the to the dramatic emergence of obesity and associated nutritional quality and safety of food, and chronic diseases. increasing the vulnerability of food-insecure individuals and households. The increased use of agricultural biodiversity will play an essential part in the adaptation and mitigation actions needed to cope with climate change, and ensuring continued sustainable supplies of healthy food, providing adaptive capacity, diverse options to cope with future change and enhanced resilience in food production systems. B. VINCETI / BIOVERSITY

22. A diversity of species, varieties and breeds, as well as wild sources (fish, plants, bushmeat, insects and fungi) underpin dietary diversity and good nutrition. Variety-specific differences within staple crops can often be the difference between nutrient adequacy and nutrient deficiency in populations and individuals. Significant differences in the nutrient content of meat and

S. PADULOSI / BIOVERSITY S. PADULOSI milk among breeds of the same animal species have also been documented. Wildlife, from 21. Agricultural practices that make improved aquatic and terrestrial ecosystems, is a critical use of agricultural biodiversity have been source of calories, protein and micronutrients identified and are being used around the like iron and zinc for more than a billion world. Their potential value needs to be more people. Fish provide more than 3 billion people widely recognized and their adoption more with important sources of protein, vitamins strongly supported through research. Support and minerals. should also be provided for appropriate policy and economic regimes, and to small- 23. Access to wildlife in terrestrial, marine scale producers. Interdisciplinary analysis and freshwater systems is critical to and cross-sectoral collaboration (among human nutrition, and global declines will the agriculture, environment, health and present major public health challenges for nutrition communities) is essential to ensure resource-dependent human populations, the integration of biodiversity into policies, particularly in low- and middle-income programmes, and national and regional plans countries. Even a single portion of local of action on food and nutrition security. traditional animal-source foods may result in significantly increased clinical levels of energy, protein, vitamin A, vitamin B6/B12,

6 Connecting Global Priorities: Biodiversity and Human Health vitamin D, vitamin E, riboflavin, iron, zinc, While fortification and biofortification may magnesium and fatty acids, thus reducing be cost–effective solutions to address specific the risk of micronutrient deficiency. The use nutrient deficiencies (e.g. vitamin A and of wild foods increases during the traditional iron), they cannot provide the full range of “hungry season” when crops are not yet ready nutrients needed. Food-based approaches can for harvest, and during times of unexpected be supported by a greater focus on nutrition household shocks such as crop failure or and biological diversity in agricultural, food illness. However, wildlife populations are system, and value chain programmes and in worldwide decline as a result of habitat policies (compared to a dominant focus on destruction, overexploitation, pollution and a few staple crops), including by promoting invasive species. Conservation strategies can traditional food systems and food cultures. therefore provide significant public health dividends. 26. Some dietary patterns that offer substantial health benefits could also reduce climate 24. The harvesting and trade of wild edible change and pressures on biodiversity. The plants and animals provides additional global dietary transition towards diets higher benefits but also risks. The collection and in refined sugars, refined fats, oils and meats trade of wild foods indirectly contributes to are increasing the environmental footprint health and well-being by providing income for of the food system as well as the incidence of household needs, particularly in less developed type 2 diabetes, coronary heart disease and countries. Aggregating across numerous local- other chronic noncommunicable diseases level studies, estimates of the annual value of (NCDs). Some traditional diets, such as the the bushmeat trade alone in west and central Mediterranean diet, and alternative vegetarian Africa range between US$ 42 million and or near-vegetarian diets, if widely adopted, US$ 205 million (at 2000 values). This scale would reduce global agricultural greenhouse of economy poses important subsistence gas emissions, reduce land clearing and benefits. Hunting, butchering, consumption, resultant species extinction, and help prevent global trade, and/ or contact in markets diet-related chronic NCDs. with other species can also present risks of transmission and spread of infectious disease. MICROBIAL DIVERSITY AND NONCOMMUNICABLE DISEASES S. LANDERSZ / BIOVERSITY

25. Food-based approaches are needed to NIAID / FLICKR help combat malnutrition and promote health. A healthy, balanced diet requires Noncommunicable diseases are becoming prevalent a variety of foods to supply the full range in all parts of the world. Some NCDs, including of nutrients needed (vitamins, minerals, autoimmune diseases, type 1 diabetes, multiple individual amino acids and fatty acids, and sclerosis, allergic disorders, eczema, asthma, other beneficial bioactive food components). inﬂammatory bowel diseases and Crohn disease

Connecting Global Priorities: Biodiversity and Human Health 7 may be linked to depleted microbial diversity in the 29. Several categories of organism with which human microbiome. we co-evolved play a role in setting up the mechanisms that “police” and regulate 27. Humans, like all complex plants and the immune system. In addition to the animals, have microbiota without which microbiota, some other organisms (the “old they could not survive. The human infections”) that caused persistent infections or microbiome contains ten times more carrier states in hunter–gatherer communities microorganisms than cells that comprise the were always present during human evolution, human body. These occur, inter alia, on the and so had to be tolerated by the immune skin, and in the gut, airways and urogenital system. Therefore, they co-evolved roles in tracts. The biodiversity of bacteria, viruses, inducing the mechanisms that regulate the fungi, archaea and protozoa, of which immune system, terminate immune activity microbes are comprised, and the interactions when it is no longer needed, and block of microbes within the complex human inappropriate attack on self (autoimmunity), microbiome influence both the physiology allergens (allergic disorders) or gut contents of and susceptibility to disease, and play an (inflammatory bowel disease). Some of these important role in the processes that link immunoregulation-inducing organisms, environmental changes and human health. for example, a heavy load of helminths, can The realization that humans are not merely have detrimental effects on health, and so “individuals” but rather complex ecosystems are eliminated by modern medicine in high- may be one of the major advances in our income settings. This increases the importance understanding of human health in recent of the immunoregulatory role of microbiota years, with significant implications for both and the microbial environment in high-income ecology and human health. settings, where these categories of organism need to compensate for loss of these “old 28. Environmental microbial ecosystems are infections”. in constant dialogue and interchange with human symbiotic ecosystems. Microbes 30. Reduced contact of people with the from the environment supplement and natural environment and biodiversity, and diversify the composition of the symbiotic biodiversity loss in the wider environment, microbial communities that we pick up leads to reduced diversity in the human from mothers and family, which in turn microbiota, which itself can lead to immune play significant roles from a physiological dysfunction and disease. The immune perspective. Our physiological requirements system needs an input of microbial diversity for microbial biodiversity are evolutionarily from the natural environment in order to determined. In addition to supplementation establish the mechanisms that regulate it. of the symbiotic microbiota by organisms from When this regulation fails, there may be the natural environment, the adaptability immune responses to forbidden targets such of the human microbiota (for example, to as our own tissues (autoimmune diseases; enable digestion of novel foods) depends type 1 diabetes, multiple sclerosis), harmless upon acquiring organisms with the relevant allergens and foods (allergic disorders, capabilities, or genes encoding necessary eczema, asthma, hay fever), or gut contents enzymes from the environment by horizontal (inflammatory bowel diseases, ulcerative gene transfer. Therefore, we need appropriate colitis, Crohn disease). Urbanization and contact with potential sources of genetic loss of access to green spaces are increasingly innovation and diversity, and our adaptability discussed in relation to these NCDs. Half of is threatened by loss of biodiversity in the gene the world’s population already lives in urban reservoir of environmental microbes. areas and this number is projected to increase markedly in the next half century, with the

8 Connecting Global Priorities: Biodiversity and Human Health most rapid increase in low- and middle- for deliberate modification and diversification income countries. Combined, these findings of the microbiota, which is emerging as an suggest an important opportunity for cross- exciting new approach to the prevention and over between health promotion and education cure of many human diseases. on biodiversity. 33. Innovative design of cities and dwellings 31. Failing immunoregulatory mechanisms, might be able to increase exposure to partly attributable to reduced contact the microbial biodiversity that our with the natural environment and physiological systems have evolved to biodiversity, lead to poor control of expect. In high-income settings, several very background inﬂammation. In high-income large studies reveal significant health benefits urban settings, there is often continuous of living near green spaces. The benefits are background inflammation, even in the greatest for people of low socioeconomic absence of a specific chronic inflammatory status. Recent data suggest that the effect is disorder. But persistently raised circulating not due primarily to exercise, and exposure levels of inflammatory mediators predispose to environmental microbial biodiversity is a to insulin resistance, metabolic syndrome, plausible explanation. This provides a strong type 2 diabetes, obesity, cardiovascular medical rationale for increased provision of disease and psychiatric disorders. Moreover, green spaces in modern cities. It might be in high-income settings, several cancers sufficient to supplement a few large green rise in parallel with the increases in chronic spaces with multiple small green spaces that inflammatory disorders, because chronic deliver appropriate microbial diversity. inflammation drives mutation, and provides growth factors and mediators that stimulate 34. Considering “microbial diversity” as tumour vascularization and metastasis. We an ecosystem service provider may need to maintain the microbial biodiversity contribute to bridging the chasm between of the environment in order to drive essential ecology and medicine/immunology, by regulation of the immune system. considering microbial diversity in public health and conservation strategies aimed 32. Understanding the factors that inﬂuence at maximizing services obtained from functional and compositional changes in ecosystems. The relationships our individual the human microbiome can contribute to bodies have with our microbiomes are a the development of therapies that address microcosm for the vital relationships our the gut microbiota and corresponding species shares with countless other organisms diseases. Disturbances in the composition with which we share the planet. and diversity of the gut microbiota are associated with a wide range of immunological, gastrointestinal, metabolic and psychiatric disorders. The required microbial diversity is obtained from the individual’s mother, from other people and animals (farms, dogs), and the natural environment. The major influences on this diversity are antibiotics, diet, and diversity loss in the environment due to urbanization and modern agricultural methods. We need to document the microbial biodiversity and the causes of diversity loss, preserve diversity, and identify the beneficial organisms and genes. These may be exploited

Connecting Global Priorities: Biodiversity and Human Health 9 INFECTIOUS DISEASES changing vector abundance, composition, and/ or distribution. Changes in land use and food production practices are among the leading drivers of disease emergence in humans. At the same time, pathogen dynamics are changing. While pathogen evolution is a natural phenomenon, factors such as global travel, climate change and use of antimicrobial agents are rapidly affecting pathogen movement, host ranges, and persistence and virulence. Beyond direct infection risks for humans and animals, CSIRO such changes also have implications for food Infectious diseases cause over one billion human security and medicine. infections per year, with millions of deaths each year globally. Both established and emerging infectious 37. Areas of high biodiversity may have large diseases cause an extensive health and ﬁnancial numbers of pathogens, yet biodiversity burden. Infectious diseases also affect plants and may serve as a protective factor for animals, which may pose threats to agriculture preventing transmission, and maintaining and water supplies, with additional impacts on ecosystems may help to reduce exposure to human health. infectious agents. While the absolute number of pathogens may be high in areas of high 35. Pathogens play a complex role in biodiversity, disease transmission to humans biodiversity and health, with benefits in is mostly determined by contact and, in some some contexts and threats to biodiversity cases, biodiversity may serve to protect against and human health in others. The pathogen exposure through host species relationships between infectious pathogens competition and other regulating functions. and host species are complex; disease and Limiting human activity in biodiverse habitats microbial composition can serve vital may reduce human exposure to high-risk regulating roles in one species or community settings for zoonotic pathogens, while serving while having detrimental effects on others. to protect biodiversity. Microbial dynamics, and their implications for biodiversity and health, are multifactorial; 38. Infectious diseases threaten wild species similarly, the role of biodiversity in pathogen as well as the people that depend on them. maintenance is not fully understood. The health burden of infectious diseases is not limited to humans and domestic species; 36. Human-caused changes in ecosystems, infectious diseases pose a threat to biodiversity such as modified landscapes, intensive conservation as well. Pathogen spillover agriculture and antimicrobial use, are can occur from one wild species to another, increasing the risk and impact of infectious potentially causing an outbreak if the species disease transmission. Approximately two or population is susceptible to the pathogen. thirds of known human infectious diseases Similarly, diseases of domestic animals and are shared with animals, and the majority humans can also be infectious to wild species, of recently emerging diseases are associated as seen with the local extinction of African wild with wildlife. Vector-borne diseases also dog populations following the introduction account for a large share of endemic diseases. of rabies virus from domestic dogs. Ebola Increasing anthropogenic activity is resulting virus has also been recognized as causing in enhanced opportunities for contact at the severe declines in great ape populations, human/animal/environment interface, which including the critically endangered wild is facilitating disease spread, and through lowland gorilla troops. Past Ebola outbreaks

10 Connecting Global Priorities: Biodiversity and Human Health in great apes have preceded human outbreaks, MEDICINES: THE CONTRIBUTION suggesting a sentinel or predictive value of OF BIODIVERSITY TO wildlife monitoring to aid in early detection THE DEVELOPMENT OF or prevention of human infections. In addition to the direct potential morbidity and PHARMACEUTICALS mortality threats from infectious diseases to the survival of wild populations, infection- related population declines may compromise the health-benefiting ecosystem services that wildlife provides. For example, major declines recently seen from fungal infections associated with White Nose syndrome in North American bats and chytrid in amphibians may affect the pest control functions that these animals provide. GENEVIÈVE ANDERSON

39. The rapidly growing number of invasive Many of the diseases that afflicted or killed species causes significant impacts on most people a century ago are largely curable or human health, and this effect is expected preventable today thanks to medicines, many of to further increase in the future, due which are derived from biodiversity. Yet, in many to the synergistic effects of biological instances, the very organisms that have given invasions and climate change. Preventing humanity vital insights into human diseases, or are and mitigating biological invasion is not only the sources of human medications, are endangered important for protecting biodiversity, but also with extinction because of human actions. for protecting human health. Through trade and travel, the number of invasive species is 40. Biodiversity has been an irreplaceable increasing globally as a consequence of the resource for the discovery of medicines globalization of economies, and the increase and biomedical breakthroughs that have is expected to intensify in the future due alleviated human suffering. Drugs derived to synergistic effects with climate change. from natural products may perhaps be the Invasive species not only impact biodiversity most direct and concrete bond that many but also affect human health causing diseases may find between biodiversity and medicine. or infections, exposing humans to bites Among the breakthroughs that dramatically and stings, causing allergic reactions, and improved human health in the twentieth facilitating the spread of pathogens. century, antibiotics rank near the top. The penicillins as well as nine of the thirteen other major classes of antibiotics in use derive from microorganisms. Between 1981 and 2010, 75% (78 of 104) of antibacterials newly approved by the United States Food and Drug Administration (USFDA) can be traced back to natural product origins. Percentages of antivirals and antiparasitics derived from natural products approved during that same period are similar or higher. Reliance upon biodiversity for new drugs continues to this day in nearly every domain of medicine.

Connecting Global Priorities: Biodiversity and Human Health 11 41. For many of the most challenging health TRADITIONAL MEDICINE problems facing humanity today, we look to biodiversity for new treatments or insights into their cures. Most of the medicinal potential of nature has yet to be tapped. Plants have been the single greatest source of natural product drugs to date, and although an estimated 400 000 plant species populate the earth, only a fraction of these have been studied for pharmacological potential. One of the largest plant specimen banks, the natural products repository at the National Cancer Institute, contains ~60 C. KRESTCH 000 specimens, for instance. Other realms of the living world, especially the microbial Millions of people rely on traditional medicine that is and marine, are only beginning to be studied dependent on biological resources, well-functioning and hold vast potential for new drugs, given ecosystems and on the associated context-speciﬁc both their diversity and the medicines already knowledge of local health practitioners. In local discovered from them. Many species, which communities, health practitioners trained in could be potential sources of medicines, are traditional and non-formal systems of medicine threatened by extinction. often play a crucial role in linking health-related knowledge to affordable health-care delivery. 42. Greater even than what individual species offer to medicine through the molecules 43. Traditional medical knowledge spans they contain or traits they possess, an various dimensions relating to medicines, understanding of biodiversity and ecology food and nutrition, rituals, daily routines yields irreplaceable insights into how life and customs. There is no single approach to works, which bear upon current epidemic traditional medical knowledge. Traditional diseases. Consider the multiple pandemics knowledge is not restricted to any that have resulted from antibiotic resistance. particular period in time, and constantly Human medicine tends to use a paradigm for undergoes re-evaluation based on local treating infections unknown in nature, which contexts. Some traditional medical systems is treating one pathogen with one antibiotic. are codified, and some even institutionalized. Most multicellular life (and a good share of They range from highly developed ways of single cellular life) produces compounds with perception and understanding, classification antibiotic properties but never uses them in systems (local taxonomies) to metaphysical isolation. Infections are attacked, or more precepts. Links to geography, communities, often prevented, through the secretion of worldviews, biodiversity and ecosystems several compounds at once. based on specific epistemologies make traditional health practices diverse and unique. By extension, the level of expertise is heterogeneous and therefore internal validation methods differ substantially, despite an underlying philosophical principle of interconnectedness of the social and natural worlds.

44. Medicinal and aromatic plants, the great majority of which are sourced from the

12 Connecting Global Priorities: Biodiversity and Human Health wild, are used in traditional medicine and sector, medical practitioners and consumers. also in the pharmaceutical, cosmetic and Appropriate market-based instruments to food industries. The global use of and trade enable sustainable and responsible utilization in medicinal plants and other biological of resources in traditional medicine are resources, including wildlife, is high and required. Value chains of traditional medicines growing. Plants used in traditional medicine can be simple and local, or global and extremely are not only important in local health care, complex. Some resources have one or a few but are also important for innovations in specific uses while others are used in many health care and associated international trade; different products and markets. In many cases, they enter various commodity chains based the people who harvest these resources have on information gathered from their use in little knowledge of the subsequent uses and traditional medical pharmacopeia. Globally, value. Ensuring equitable economic returns an estimated 60 000 species are used for their to local communities by promoting value- medicinal, nutritional and aromatic properties added activities at the local level could help to and, every year, more than 500 000 tons of harness the knowledge of local communities material from such species are traded. It is on medicinal resources and promote their estimated that the global trade in plants for sustainable use. medicinal purposes reaches a value of over US$ 2.5 billion and is increasingly driven by 47. Sui generis models may need to be industry demand. developed and applied to secure the rights of indigenous peoples and local 45. Threats to medicinal plants, animals and communities over traditional medical other medicinal resources are increasing. knowledge and related resources. Wild plant populations are declining – one in Traditional medical knowledge is often five species is estimated to be threatened with an inspiration for industrial research and extinction in the wild. Animals (amphibians, development (R&D) processes in bioresource- reptiles, birds, mammals) used for food and based sectors, necessitating mechanisms to medicine are more threatened than those not secure appropriate attribution and sharing of used. Overharvesting, habitat alteration and rights and benefits with knowledge holders, climate change are among the major drivers as set out in the Nagoya Protocol on Access of declines in commercially important wild to genetic resources and equitable sharing plant resources used for food and medicinal of benefits arising from their commercial purposes. These pose a threat both to the wild utilization. It would be beneficial to strengthen species and to the livelihoods of collectors, and promote existing tools, databases and who often belong to the poorest social groups. registers, and intellectual property rights that There is a clear need to continue efforts at are sensitive to community values. developing assessment methods and indicators for conservation and sustainable use. 48. Improving public health outcomes and achieving the objectives of “Health for 46. Sustainable use of medicinal resources can All” and “Good Health at Low Cost” should provide multiple benefits to biodiversity, include traditional medical care, and the livelihoods and human health, in development of appropriate integrative particular, relating to their affordability, methodologies and safety standards within accessibility and cultural acceptability. and across medical systems. More than one Sustainable medicinal resource management third of the population in many developing for both captive breeding and wild collection countries do not have access to modern health is crucial for the future of traditional medicine. care, and are dependent on traditional medical This involves all stakeholders, including systems. There is high patronage of and conservationists, the private health-care dependence on traditional health practitioners

Connecting Global Priorities: Biodiversity and Human Health 13 to provide care to people with inadequate for depression, anxiety and behavioural access to modern health infrastructure or problems, including for children. Exposure with a preference for traditional systems. to nature is important for childhood Pluralistic approaches that integrate natural development, and children who grow up with resources and medical knowledge, and are knowledge about the natural world and the sensitive to local priorities and contexts, can importance of conservation may be more enable better health outcomes. This implies likely to conserve nature themselves as adults. the need to develop cross-sectoral, cost– Conversely, it has been stipulated that children effective measures to test the safety, efficacy in developed countries increasingly suffer from and quality of traditional medicines, integrate a “nature-deficit disorder”, due to a reduction traditional healers in the health-care system in the time spent playing outdoors as a result through appropriate accreditation practices of increased use of technology and parental/ and processes, promote cross-learning societal fears for child safety. On the other between different knowledge systems and hand, some research has suggested that some disciplines through participatory, formal and children, particularly those from urban areas, informal learning processes to supplement are fearful of spending time in certain natural current practices in a culturally sensitive way. habitats (woodland and wetland) owing to perceived threats from isolation, wild animals BIODIVERSITY AND MENTAL, or the actions of other people. PHYSICAL AND CULTURAL WELL- 50. Exposure to green spaces may have positive BEING impacts on mental health. Depression accounts for 4.3% of the global burden It is well established that biodiversity is a central of disease and is among the largest single component of many cultures and cultural traditions, causes of disability worldwide, particularly and there is evidence that exposure to nature and among women. Some studies of populations more biodiverse environments can also provide in developed countries have suggested that mental and physical health beneﬁts. Over half adults exposed to green spaces report fewer of the world’s population lives in cities and that symptoms and a lower overall incidence of proportion is increasing. There is a rising trend certain diseases than others, and that the for people, especially from poor communities, to relationship is strongest for mental illnesses be separated from nature and be deprived of the such as depression, anxiety and stress. physical, physiological and psychological beneﬁts Similarly, beneficial mental health impacts that nature provides. have been associated with greater exposure to microbial diversity. Other research has indicated that experience of nature can reduce recuperation times and improve recovery outcomes in hospital patients.

51. Access to natural green spaces can increase levels of physical activity with benefits for health. The benefits of physical activity may include a reduced risk of several NCDs, as well as improved immune function. It may also provide mental health benefits, and GLEN BOWES facilitate social connections and independence. 49. The interaction with nature – including Among populations for which access to domestic animals, and wild animals in wild open countryside is limited, particularly settings – may contribute to treatments those in poorer inner-urban areas of large

14 Connecting Global Priorities: Biodiversity and Human Health cities, access to green spaces in the urban sites), and related traditional knowledge environment can encourage regular physical practices can have therapeutic value and activity and improve life expectancy. It has contribute to health and well-being. also been suggested that health benefits may be more significantly attributable to enhanced 53. Significant changes to local biodiversity or exposure to environmental microbes in green ecosystem sustainability can have specific spaces. There is evidence that biodiversity and unique impacts on local community encourages the use of urban green spaces. health, where the physical health of a Efforts to develop biodiverse settings, community is directly inﬂuenced by or including wildlife-rich gardens, can also boost dependent upon ecosystem services, physical activity in sedentary and vulnerable particularly regarding access to diverse patients and residents. While the potential food and medicinal species. Indigenous and that green spaces can offer for promoting and local communities often act as stewards of local enhancing physical fitness is still not fully living natural resources based on generations of recognized, there is a growing interest in many accumulated traditional knowledge, including countries to promote and enhance “green and knowledge of agricultural biodiversity, blue infrastructure” (terrestrial and aquatic and biodiversity that supports traditional environments) within tourism, public health medicinal knowledge. Where local traditions and environmental policies. and cultural identity are closely associated with biodiversity and ecosystem services, declines in the availability and abundance of such resources can have a detrimental impact on community well-being, with implications for mental and physical health, social welfare and community cohesion.

54. While many community-specific links between health, culture and biodiversity have been documented and measured, much of the evidence for a more universal

B. SHAPIT / BIOVERSITY relationship is relatively sparse beyond anecdotal accounts. However, there is 52. Biodiversity is often central to cultures, growing recognition of the role of biodiversity cultural traditions and cultural well- being. and ecosystem services in shaping broad Species, habitats, ecosystems and landscapes perspectives of quality of life. influence forms of music, language, art, literature and dance. They form essential elements of food production systems, IMPACTS OF PHARMACEUTICAL culinary traditions, traditional medicine, PRODUCTS ON BIODIVERSITY AND rituals, worldviews, attachments to place and CONSEQUENCES FOR HEALTH community, and social systems. Use of the WHO Quality Of Life Assessment (devised to Antibiotics and other pharmaceuticals are essential determine an individual’s quality of life in the for human health and also play an important role context of their culture and value systems) has in veterinary medicine. However, the release of shown that the environmental domain is an active pharmaceutical ingredients (APIs) into the important part of the quality-of-life concept. environment can be harmful to biodiversity, with Socioecological production landscapes (e.g. negative consequences for human health. Satoyama in Japan) or conservation systems (e.g. sacred groves, ceremonial sites) or 55. The release of pharmaceuticals and therapeutic landscapes (e.g. sacred healing APIs into the environment can have an

Connecting Global Priorities: Biodiversity and Human Health 15 impact on biodiversity, ecosystems and antibacterial products and antibiotics may ecosystem service delivery and may, in also be linked to the increase in chronic turn, negatively impact human health. inflammatory disorders, including allergies A range of pharmaceuticals, including such as asthma and eczema, because they hormones, antibiotics, antidepressants reduce exposure to microbial agents that set up and antifungal agents, has been detected in the regulation of the immune system. Limiting rivers and streams across the world. Most the use of antimicrobial agents could provide pharmaceuticals are designed to interact with potential co-benefits for human health and a target (such as a specific receptor, enzyme biodiversity, reducing chronic inflammatory or biological process) in humans and animals diseases through a healthy and more diverse to deliver the desired therapeutic effect. If human microbiota while also reducing the risk these targets are present in organisms in of emerging disease from antibiotic-resistant the natural environment, exposure to some strains and the potential impacts of antibiotics pharmaceuticals might be able to elicit effects on ecosystems more broadly. in those organisms. Pharmaceuticals can also cause side-effects in humans and it is possible 57. The inappropriate use of antibiotics in that these and other side-effects can also occur plants, animals and humans has cultivated in organisms in the environment. During the numerous highly resistant bacterial life cycle of a pharmaceutical product, APIs strains. In some instances, resistant bacterial may be released into the natural environment, strains cannot be effectively treated with any including during the manufacturing process currently available antibiotic. Promoting the via human or domestic animal excretion responsible and prudent use of antibiotics and into sewage systems, surface water or soils, antimicrobials in human health, agricultural when contaminated sewage sludge, sewage practices and food production systems effluent or animal manure is applied to can achieve public health and biodiversity land. APIs may also be released into the soil co-benefits. Poorly managed industrial environment when contaminated sewage agricultural practices contribute to ecosystem sludge, sewage effluent or animal manure is degradation, air and water pollution, and soil applied to land. Veterinary pharmaceuticals depletion, and rely heavily on the inappropriate may also be excreted directly to soils by pasture use of antibiotics for both therapeutic as well animals. Measures are needed to reduce this as prophylactic (growth promotion) use. This environmental contamination. may lead to environmental dispersion of antimicrobial agents, antibiotic resistance, and 56. Antibiotic and antimicrobial use can reduced efficacy in subsequent use for medical alter the composition and function of the or food production applications. From a health human microbiome, and limiting their perspective, the use of antimicrobials and use would provide biodiversity and health antibiotics may disrupt microbial composition, co-benefits. Antibiotic use can dramatically including the relationships between hosts and alter the composition and function of the their symbiotic microbes, and lead to diseases. human microbiome. Although much of the At the same time, antibiotic resistance in microbiome and its relationship to its host any environment can pose serious threats remains unexplored, what is already apparent to public health. Aside from its potential to is that changes to the variety and abundance cultivate resistance, antibiotic use also carries of various microorganisms, as can occur with the potential to disrupt symbiotic bacterial antibiotic use, may affect everything from composition. the host’s weight and the risk of contracting autoimmune disease, to susceptibility to 58. Endocrine-disrupting chemicals found infections. The microbiome may also be able in pharmaceutical products and in many to affect mood and behaviour. The use of household, food and consumer products,

16 Connecting Global Priorities: Biodiversity and Human Health have adverse effects on the health of GLOBAL ADAPTATION TO CLIMATE terrestrial, freshwater and marine wildlife, CHANGE AND DISASTER RISK and of humans. The use of contraceptive REDUCTION hormones and veterinary growth hormones have been linked to endocrine disruption and reproductive dysfunction in wildlife. They also affect both male and female human reproduction, and have been linked to prostate cancer, and neurological, endocrinological, thyroid, obesity, and cardiovascular problems. Biodiversity has also been a good monitor for some of these human health problems. In

some cases, health specialists were alerted SANZI (USAF) AIRMAN 1ST CLASS CHERYL to the scale of a potential problem through 60. Climate change is already negatively changes originally recorded in wild fish impacting on human health and these populations. impacts are expected to intensify. The 59. The inappropriate use of some non- direct effects of climate change on health may steroidal anti-inflammatory drugs and include stroke and dehydration associated other veterinary drugs threatens wildlife with heat waves (particularly in urban areas), populations. For example, in the 1980s, negative health consequences associated with populations of three previously abundant reduced air quality and the spread of allergens. vulture species in South Asia were reduced to Effects are also mediated through the impacts near extinction due to the use in livestock of on ecosystems and biodiversity. Such effects diclofenac, residues of which remained in the may include decreased food production and carcasses of treated animals. This led to negative changes in the spread of climate-sensitive impacts on human health through the spread waterborne and water-related, foodborne of diseases by feral dogs, as access to carcasses and vector-borne diseases. There may be increased, especially among communities synergistic effects of climate change, land- who rely on vultures to consume their dead. use change, pollution-invasive species and Following bans on the use of diclofenac and other drivers of change, which can amplify its replacement by meloxicam, the decline the impacts on both health and biodiversity. in vulture populations has slowed and some 61. Climate change will not only affect show signs of recovery in the region. Without agricultural production systems but also proper risk assessment and regulation, the the nutritional content of foods, and the marketing and use of pharmaceuticals used distribution and availability of fisheries. for livestock may continue to pose threats to Changes in temperature and precipitation human and wildlife health. patterns will have complex effects, but the net effect on food production will be negative. While rising levels of atmospheric carbon tend to increase productivity, they will lead to reduced concentrations of minerals such as zinc and iron in crops such as wheat and rice. With regard to marine fisheries, while there would be increased productivity at high latitudes, there will be decreased productivity at low/mid latitudes, affecting poor developing countries.

Connecting Global Priorities: Biodiversity and Human Health 17 62. Disasters may be precipitated by impacts than communities with greater ecological on critical ecosystems or the collapse of security. essential ecosystem services. Disasters may include disease epidemics, flooding, storms, 65. Biodiversity helps to improve the extreme weather and wildfires. Some of these resilience of ecosystems, contributing may be precipitated by ecosystem disruption. to adaptation to climate change and There has been an increase in the frequency moderating the impacts of disasters. and intensity of some climate-related Ecosystem-based adaptation and mitigation extreme events in recent years. Ecosystem strategies are needed to build the resilience degradation can increase the vulnerability of of managed landscapes and jointly reduce the human populations to such disasters. New vulnerabilities of ecosystems and communities environmental impacts often occur during and reliant upon them for their health, livelihoods after an emergency with an increased demand and well-being. For example, ecosystem- for certain natural resources, which can place based approaches to flood-plain and coastal additional stress on specific ecosystems development can reduce human exposure (such as groundwater resources) and their to risks from flooding. Coral reefs are very functioning. effective in protecting against coastal hazards (reducing wave energy by 97%) and protect 63. Competition over access to ecosystem over 100 million people in this way from goods and services can contribute to, coastal storm surges. The conservation and use and become a cause of, conflict, with of genetic resources in agriculture, aquaculture consequences that can negatively impact and forestry is important to allow crops, trees, ecosystem goods and services in both the fish and livestock to adapt to climate change. short- and long term. Greater recognition needs to be given to the potential positive role SUSTAINABLE CONSUMPTION AND that conservation and ecosystem management can play in conflict prevention and resolution PRODUCTION and peace-building, while the converse also 66. Increased pressure on the biosphere, holds good. driven by increasing human populations and per-capita consumption, threatens 64. The creation of disaster-resilient societies biodiversity and human health. Biosphere is increasingly tied to and dependent upon integrity is threatened by a number of resilience in ecosystems, and sustainability interacting drivers, including climate change, and security in the ﬂow and delivery of land-use change, pollution and biodiversity essential ecosystem goods and services. loss. The global population is projected to This includes not only those goods and increase to nine to ten billion by 2050, and services directly associated with resilience to may continue to increase in this century. immediate disaster impacts, but also those Greater investment in education of girls and that normally support communities and the women and improved access to contraceptive wider society. Long-term health status is information and family-planning services an important indicator of the resilience of can improve human health and well-being a community – as a marker for capacity to directly and also help to slow these trends, overcome or adapt to health challenges and potentially reducing pressures on ecosystems. other social, environmental and economic Under business-as-usual scenarios, increased pressures. Communities whose ability to per-capita consumption will lead to even overcome current challenges are affected by greater pressures on the biosphere. Slowing ecosystem degradation at the time of a disaster these trends requires improvements in event – natural or human induced – are likely energy and resource-use efficiency, including to be significantly more vulnerable to disasters decarbonization of energy supplies in this

18 Connecting Global Priorities: Biodiversity and Human Health century. These changes will need to be of behavioural change, production and complemented by increased equality in consumption patterns, policy development, access to and use of energy and other natural and the use of non-market tools. There is resources. a need for more effective communication, education and public awareness to be spread 67. Alternative scenarios to 2050, as well as more widely through school systems and practical experience, demonstrate that it is other channels, and to devise communication possible to ensure food security and reduce and awareness strategies on biodiversity and poverty while also protecting biodiversity health. and addressing climate change, and attain other human development goals, but this requires transformational change. STRATEGIES FOR HEALTH AND Scenario analyses show that there are multiple BIODIVERSITY plausible pathways to simultaneously achieve 69. Health and biodiversity strategies could be globally agreed goals. Common elements of developed with the aim of ensuring that these pathways include: reducing greenhouse the biodiversity and health linkages are gas emissions from energy and industry; widely recognized, valued, and reﬂected increasing agricultural productivity and in national public health and biodiversity containing agricultural expansion to prevent strategies, and in the programmes, plans, further biodiversity loss and avoid excessive and strategies of other relevant sectors, greenhouse gas emissions from conversion with the involvement of local communities. of natural habitats; restoring degraded land The implementation of such strategies and protecting critical habitats; managing could be a joint responsibility of ministries biodiversity in agricultural landscapes; reducing of health, environment, and other relevant nutrient and pesticide pollution and water use; ministries responsible for the implementation reducing post-harvest losses in agriculture, of environmental health programmes and and food waste by retailers and consumers, national biodiversity strategies and action as well as moderating the increase in meat plans. Such strategies would need to be tailored consumption. Implementing these measures to the needs and priorities of particular requires a package of actions, including legal countries. Such strategies might include the and policy frameworks, economic incentives, following objectives: and public and stakeholder engagement. Coherence of policies and coordination across a. Promoting the health benefits provided by sectors are essential. biodiversity for food security and nutrition, water supply and other ecosystem services, 68. Behavioural change is needed to improve pharmaceuticals and traditional medicines, human health and protect biodiversity. mental health, and physical and cultural Human behaviour, which is informed by well-being. In turn, this provides a rationale differences in knowledge, values, social norms, for the conservation and sustainable use of power relationships and practices, is at the biodiversity, as well as the fair and equitable core of the interlinkages between health and sharing of benefits; biodiversity, including challenges related to food, water, disease, medicine, physical and b. Managing ecosystems to reduce the risks mental well-being, adaptation and mitigation of infectious diseases, including zoonotic of climate change. There is a need to draw and vector-borne diseases, for example, by upon the social sciences to motivate choices avoiding ecosystem degradation, preventing consistent with health and biodiversity invasive alien species, and limiting or objectives, and to develop new approaches controlling human–wildlife contact; through, inter alia, better understanding

Connecting Global Priorities: Biodiversity and Human Health 19 c. Addressing the drivers of environmental indicators, including threshold values for change (deforestation and other ecosystem critical ecosystem services, such as the loss, and degradation and chemical availability and access to food, water and pollution) that harm both biodiversity medicines. and human health, including direct health impacts and those mediated by biodiversity TOOLS, METRICS AND FURTHER loss; RESEARCH d. Promoting lifestyles that might contribute 70. Integration of biodiversity and human jointly to positive health and biodiversity health concerns will require the use outcomes (for example, protecting of common metrics and frameworks. traditional foods and food cultures, Conventional measures of health are promoting dietary diversity); often too limited in focus to adequately encompass the health benefits of biodiversity. e. Addressing the unintended negative impacts Notwithstanding the broad WHO definition of health interventions on biodiversity of health, traditional measures of health, such (for example, antibiotic resistance, as disability-adjusted life years (DALYs) and contamination from pharmaceuticals), and burden of disease, tend to have a narrower focus incorporating ecosystem concerns into on morbidity, mortality and disability, and fail public health policies; to capture the full breadth of complex linkages between biodiversity and health. Alternative f. Addressing the unintended negative metrics defining health are needed to reflect impacts of biodiversity interventions on the broad aspects of human health and well- health (for example, effect of protected being. Further, to increase collaboration across areas or hunting bans on access to food and disciplines and sectors, more attention could medicinal plants); be paid to “translating” the meaning of key g. Adopting the One Health approach or metrics to increase shared relevance. Similarly, other integrative approaches that consider frameworks provide a conceptual structure to connections between human, animal build on for research, demonstration projects, and plant diseases, and promote cross- policy and other purposes. Embracing a broad disciplinary synergies for health and framework that aims to maximize the health biodiversity; of both ecosystems and humans could help the different disciplines and sectors work more h. Educating, engaging and mobilizing the collaboratively. The conceptual framework of public and the health sector, including the Intergovernmental science-policy Platform professional health associations as on Biodiversity and Ecosystem Services potential, powerful advocates for the (IPBES), building upon that articulated in sustainable management of ecosystems. the Millennium Ecosystem Assessment, links Mobilize organizations and individuals who biodiversity to human well-being, considering can articulate the linkage and the enormous also institutions and drivers of change. value proposition that investments in sustainable ecosystem management 71. The development of comparable tools – and provide to the social and economic health maximizing the use of existing tools – to of communities; promote a common evidence base across sectors is needed. Tools ranging from i. Monitoring, evaluating and forecasting systematic assessment processes (for progress toward the achievement of example, environmental impact assessments, national, regional and global targets at strategic environmental assessments, risk regular intervals against evidence-based assessments and health impact assessments)

20 Connecting Global Priorities: Biodiversity and Human Health to the systematic reviews of research findings, and human health linkages. Common on the to standardized data collection forms to health side are environmental hazard or risk computerized modelling programs should factor analyses. Others include identifying also consider health–biodiversity linkages to and reducing health disparities/inequities; manage future risks and safeguard ecosystem focusing on environmental and socioeconomic functioning, while ensuring that social costs, determinants of disease, and conducting including health impacts, associated with health impact assessments. Conservation new measures and strategies do not outweigh approaches include land-/seascape-change potential benefits. modelling, vulnerability and adaptation assessments, linked health and environmental 72. The development of precautionary policies assessments, and ecosystem service analyses. that place a value on ecosystem services to health, and make positive use of linkages 75. Further research is needed to elucidate between biodiversity and health are some of the potential knowledge gaps in needed. For example, integrated disease linkages between biodiversity and human surveillance in wildlife, livestock and human health. Examples of key questions include the populations is a cost–effective measure to following: promote early detection, and avoid the much greater damage and costs of disease outbreaks. a. What are the relationships between biodiversity, biodiversity change and 73. Measuring the health effects of ecosystem infectious diseases? Specifically, what are change by considering established the effects of species diversity, habitat “exposure” threshold values helps highlight disturbance and human–wildlife contact? biodiversity–health–development What are the implications for spatial linkages. Mechanisms linking ecosystem planning? change to health effects are varied. For many sub-fields, exposure thresholds or standards b. What are the linkages between biodiversity have been scientifically established, which (including biodiversity in the food serve as trigger points for taking action to production system), dietary diversity and avoid or minimize disease or disability. For health? Is there a relationship between example, air quality standards exist for particle dietary biodiversity and the composition and pollution, WHO has established minimum diversity of the human microbiome? What quantities of per-capita water required to meet are good indicators of dietary biodiversity? basic needs, and thresholds for food security What are the cumulative health impacts of define the quantity of food required to meet ecosystem alteration? individual daily nutritional needs. Measuring the health effects of ecosystem change relative THE SUSTAINABLE DEVELOPMENT to established threshold values highlights GOALS AND POST-2015 how such change constitutes exposure – an important principle linking cause and disease SUSTAINABLE DEVELOPMENT or other health effects – and encourages action AGENDA if thresholds are exceeded. 76. Health and biodiversity, and the linkages among them and with other elements of 74. Economic valuation approaches linking sustainable development, must be well ecosystem functioning and health, integrated into the post-2015 development which support decisions about resource agenda. The post-2015 development agenda allocation, may appeal to a variety of provides a unique opportunity to advance stakeholders. Many approaches enhance the parallel goals of improving human health understanding of ecosystem functioning and protecting biodiversity. The Sustainable

Connecting Global Priorities: Biodiversity and Human Health 21 Development Goals (SDGs) will address may exacerbate climatic pressures may also various aspects of human well-being and lead to greater food insecurity, particularly be accompanied by targets and indicators. among poor and vulnerable populations, Specific biodiversity-related targets and by negatively influencing its availability, indicators should be integrated into Goals accessibility, utilization and sustainability. on food security and nutrition, water and health. The SDG framework should also 78. Health is our most basic human right provide for enabling conditions for human and therefore one of the most important health, and conservation and sustainable indicators of sustainable development. use of biodiversity, and for the underlying At the same time, conservation and drivers of both biodiversity loss and ill- sustainable use of biodiversity is health to be addressed. This implies Goals for imperative for the continued functioning of improved governance, and institutions, at ecosystems at all scales, and for the delivery appropriate scales (from local to global), for of ecosystem services that are essential for the management of risks and the negotiation human health. There are many opportunities of trade-offs among stakeholder groups, where for synergistic approaches that promote both they exist, as well as for behavioural change. biodiversity conservation and the health of humans. However, in some cases, there must 77. Ongoing evaluation of the synergistic and be trade-offs among these objectives. Indeed, antagonistic effects of complementary because of the complexity of interactions sustainable development goals and among the components of biodiversity at targets is needed. This includes sustainable various tropical levels (including parasites development goals and targets addressing and symbionts), and across ecosystems at health, food and freshwater security, climate various scales (from the planetay-scale biomes change and biodiversity loss. Evaluation to human– microbial interactions), positive, of the long-term impacts of trade-offs is negative and neutral links are likely to occur needed; such as the trade-off and short- simultaneously. An enhanced understanding term gains from intensive and unsustainable of health–biodiversity relationships will allow agricultural production against longer-term for the adjustment of interventions in both nutritional security. For example, the impacts sectors, with a view to promoting human well- of unsustainable agricultural practices that being over the long term.

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Connecting Global Priorities: Biodiversity and Human Health Summary of the State of Knowledge Review