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Charting a Path to Health for All at Net-Zero Emissions
Climate change is the defining health challenge of the 21st century, with record-breaking temperatures and extreme weather events already exacting an unprecedented toll on human health and wellbeing. Scientific consensus is clear: rapid and deep reductions in greenhouse gas (GHG) emissions by 2050 are needed not only to reduce the risks of exceeding climate tipping points beyond which irreversible damage occurs to natural systems, but also to safeguard human health, wellbeing, and equity. Despite growing awareness of the climate–health nexus, climate interventions often fail to consider opportunities to maximise co-benefits.
Read moreParks and Social Capital: An Analysis of the 100 Most Populous U.S. Cities
Figure 1. 2024 ParkScore methodology. Each city receives two values in the ParkScore index: a rating on a scale of 100 points (100 is high) and a ranking, with each city ranked on a scale of 1–100 (1 is high), regardless of the magnitude differences among rating scores. In recent years, much attention has focused on strategies to reverse the decline of social capital in the United States. Increased social capital, which includes both intergroup contact and civic engagement, has many important benefits. For low-income individuals, friendships with high-income individuals (“economic connectedness”, a measure of inter-group contact) are one of the strongest predictors of their ability to escape poverty and gain increased life opportunities. Volunteering, a measure of civic engagement, is hypothesized to be key in building trust among neighbors. Urban parks are often thought to be a ‘third place’ that may increase social capital within a community through both increased “mixing and mingling” and increased civic engagement. This study finds that residents of cities with better quality park systems (as measured by the ParkScore® index) are more socially connected and engaged with their neighbors (as measured by the Social Capital Atlas) than are residents of cities with lower-ranking park systems. Relative to the bottom 25 ranked cities, the top 25 ParkScore cities had 26 % more social connections between different income groups, 61 % more volunteers per capita, and 45 % more civic organizations per capita. These patterns held after controlling for other factors such as education, race/ethnicity, poverty, and family structure. These other factors often had stronger associations with the social capital indicators, suggesting park systems are an important, but not primary, driver of a community’s social capital. People living in cities with more parks and recreational opportunities may be more likely to realize these important benefits. Highlights Residents of cities with highly-ranked park systems are more socially connected than those in lower-ranked cities. Park systems are an important, but not primary, driver of a community’s social capital. Social capital has important benefits e.g. economic mobility for low-income individuals and increased trust among neighbors.
Read moreSafeguarding Nature and Cities in a Burning Country
Raging fires around Los Angeles are another stark reminder of how deeply our lives are intertwined with nature. Fires in the western USA — as with fires around Athens, Sydney or Valparaiso — expose not only the vulnerability of urban communities but also the neglect and overexploitation of the natural systems that sustain us and protect cities. As flames consumed forests, homes and infrastructure in Los Angeles in early 2025 (destroying 16,000 buildings, with thousands more facing continued risk), the controversies around fire prevention and management are likely to burn through political opportunities to build a common vision for a resilient and sustainable future in and around urban areas. Although the Los Angeles fires and political shifts in Washington cast attention on the USA, recent climate emergencies and political transitions to the right or extreme-right internationally call for invoking shared values in the management of the climate crisis and the protection of natural resources.
Read moreBuilt Environment and Public Health: More Than 20 Years of Progress
FIGURE 1— Built Environment and Health Articles Indexed by Four Databases, 2003–2022 Fall 2023 marked 20 years since the AJPH “Built Environment and Health” (BEH) special issue.1 The issue highlighted the reengagement of health and design professions and growing interest in the built environment’s potential to improve health. Public health and urban planning linkages were not new. Late 19th- and early 20th-century efforts to improve air, water, food, and housing quality; sanitation; and workplace safety contributed to better quality of life and increased life expectancy. The sectors became isolated over time, with little collaboration until recent decades. The anniversary of the special issue offers an opportunity to inventory progress in BEH: combined perspectives from public health, urban planning, architecture, transportation, and related fields on how the physical components of where we live, work, learn, and play influence health. The following sections contain an overview of BEH progress in research, practice, education, and policy, as well as current context and future priorities.
Read moreHealth Professionals and the Climate Crisis
Health professionals from every corner of the health sector—from allergy to vascular surgery, from epidemiology to environmental health, from nursing to hospital administration—have recognized the magnitude and urgency of the climate crisis. A growing literature provides guidance on how to conceptualize and meet the vast challenges we face and on how to keep our spirits up as we do so.
Read morePhysical Activity in Natural Settings: An Opportunity for Lifestyle Medicine
Physical activity is a well-known behavior for promoting health and preventing a variety of chronic diseases. Despite widespread knowledge of the benefits of physical activity, most Americans do not engage in sufficient physical activity. Over the past decade, there has been increasing recognition of the health benefits of spending time in nature, mediated in part through physical activity. This has led to new partnerships across health, parks and recreation, public lands, and environmental organizations to increase time spent, and physical activity, in natural settings. This review assesses the current evidence around physical activity in natural settings (PANS), strategies for promoting PANS including health professional engagement, and current gaps in the research literature. Related Media Does Greenspace Plus Exercise Boost the Individual Health Benefits of Each? (June 11, 2024)
Read morePromoting Health Through Nature-Based Climate Solutions
Nature-based climate solutions represent a set of strategies and tools that can help mitigate carbon emissions, remove carbon dioxide from the atmosphere, promote adaptation to climate change, and build resilience. They need to be implemented as part of an integrated set of climate actions. They aim to accomplish specific mitigation and adaptation goals effectively, economically, and safely. They deliver a wide range of co-benefits, including co-benefits for health and well-being. Nature-based climate solutions can cause unintended and even harmful consequences, and therefore need to be carefully planned, implemented, and managed. This chapter explores nature-based climate solutions in cities as well as in rural and wildland areas. It discusses tradeoffs, policy levers, economic levers, communications, and equity considerations that arise in implementing nature-based climate solutions. The chapter also includes a textbox on ecosystem services and nature’s services to people, and a textbox on the number of trees that the world can support.
Read moreHope, Health, and the Climate Crisis
Hope has been viewed since ancient times as a bedrock of human thriving, and contemporary evidence suggests that hope is a determinant of health. However, the climate crisis, in addition to its many direct and indirect threats to human health, erodes hope in many people. This article describes medical aspects of hope and hopelessness, including clinical definitions, measurement methods, and treatments. It then touches on literary and philosophical perspectives on hope, from both ancient and modern sources, emphasizing the centrality of hope to human thriving. Finally, it applies these clinical and cultural perspectives to the climate crisis, arguing that health professionals should propel hope in themselves, their patients, and the broader society, and drawing on clinical insights to propose concrete ways of doing so.
Read moreMaking Healthy Places: Designing and Building for Well-Being, Equity, and Sustainability
In Making Healthy Places, Second Edition: Designing and Building for Well-Being, Equity, and Sustainability, planning and public health experts Nisha D. Botchwey, Andrew L. Dannenberg, and Howard Frumkin bring together scholars and practitioners from across the globe in fields ranging from public health, planning, and urban design, to sustainability, social work, and public policy. This updated and expanded edition explains how to design and build places that are beneficial to the physical, mental, and emotional health of humans, while also considering the health of the planet. This edition expands the treatment of some topics that received less attention a decade ago, such as the relationship of the built environment to equity and health disparities, climate change, resilience, new technology developments, and the evolving impacts of the COVID-19 pandemic. Drawing on the latest research, Making Healthy Places, Second Edition imparts a wealth of practical information on the role of the built environment in advancing major societal goals, such as health and well-being, equity, sustainability, and resilience. This update of a classic is a must-read for students and practicing professionals in public health, planning, architecture, civil engineering, transportation, and related fields.
Read moreMore Green, Less Lonely? A Longitudinal Cohort Study
Figure 1. Association between green space within 1600 m and cumulative incidence of loneliness in all participants, and among those living alone at baseline and follow-up Both models were fully adjusted, including age group, sex, children, cohabitation status, percentage green space within 1600 m, highest educational qualifications, annual household income, % of last 12 months spent unemployed, disability or limiting long-term health condition, area-level socio-economic circumstances. Background Urban greening may reduce loneliness by offering opportunities for solace, social reconnection and supporting processes such as stress relief. We (i) assessed associations between residential green space and cumulative incidence of, and relief from, loneliness over 4 years; and (ii) explored contingencies by age, sex, disability and cohabitation status. Methods Multilevel logistic regressions of change in loneliness status in 8049 city-dwellers between 2013 (baseline) and 2017 (follow-up) in the Household, Income and Labour Dynamics in Australia study. Associations with objectively measured discrete green-space buffers (e.g. parks) (<400, <800 and <1600 m) were adjusted for age, sex, disability, cohabitation status, children and socio-economic variables. Results were translated into absolute risk reductions in loneliness per 10% increase in urban greening. Results The absolute risk of loneliness rose from 15.9% to 16.9% over the 4 years; however, a 10% increase in urban greening within 1.6 km was associated with lower cumulative incident loneliness [odds ratio (OR) = 0.927, 95% confidence interval (CI) = 0.862 to 0.996; absolute risk reduction = 0.66%]. Stronger association was observed for people living alone (OR = 0.828, 95% CI = 0.725 to 0.944). In comparison to people with <10% green space, the ORs for cumulative incident loneliness were 0.833 (95% CI = 0.695 to 0.997), 0.790 (95% CI = 0.624 to 1.000) and 0.736 (95% CI = 0.549 to 0.986) for 10–20%, 20–30% and >30% green space, respectively. Compared with the <10% green-space reference group with 13.78% incident loneliness over 4 years and conservatively assuming no impact on incident loneliness, associations translated into absolute risk reductions of 1.70%, 2.26% and 2.72% within populations with 10–20%, 20–30% and >30% green space, respectively. These associations were stronger again for people living alone, with 10–20% (OR = 0.608, 95% CI = 0.448 to 0.826), 20–30% (OR = 0.649, 95% CI = 0.436 to 0.966) and >30% (OR = 0.480, 95% CI = 0.278 to 0.829) green space within 1600 m. No age, sex or disability-related contingencies, associations with green space within 400 or 800 m or relief from loneliness reported at baseline were observed. Conclusions A lower cumulative incidence of loneliness was observed among people with more green space within 1600 m of home, especially for people living alone. Potential biopsychosocial mechanisms warrant investigation.
Read moreWhat Next? Expanding our View of City Planning and Global Health, and Implementing and Monitoring Evidence-Informed Policy
Figure 1. The pathways through which urban and transport planning decisions affect health This Series on urban design, transport, and health aimed to facilitate development of a global system of health-related policy and spatial indicators to assess achievements and deficiencies in urban and transport policies and features. This final paper in the Series summarises key findings, considers what to do next, and outlines urgent key actions. Our study of 25 cities in 19 countries found that, despite many well intentioned policies, few cities had measurable standards and policy targets to achieve healthy and sustainable cities. Available standards and targets were often insufficient to promote health and wellbeing, and health-supportive urban design and transport features were often inadequate or inequitably distributed. City planning decisions affect human and planetary health and amplify city vulnerabilities, as the COVID-19 pandemic has highlighted. Hence, we offer an expanded framework of pathways through which city planning affects health, incorporating 11 integrated urban system policies and 11 integrated urban and transport interventions addressing current and emerging issues. Our call to action recommends widespread uptake and further development of our methods and open-source tools to create upstream policy and spatial indicators to benchmark and track progress; unmask spatial inequities; inform interventions and investments; and accelerate transitions to net zero, healthy, and sustainable cities.
Read moreAn Ecosystem Service Perspective on Urban Nature, Physical Activity, and Health
Figure 1. Conceptual model of the relationships among urban nature (as part of the urban system), PA (quantity and quality), and health, alignedwith an ecosystem service approach. Numbers correspond with The Current State of Knowledge points 1 and 2. Nature underpins human well-being in critical ways, especially in health. Nature provides pollination of nutritious crops, purification of drinking water, protection from floods, and climate security, among other well-studied health benefits. A crucial, yet challenging, research frontier is clarifying how nature promotes physical activity for its many mental and physical health benefits, particularly in densely populated cities with scarce and dwindling access to nature. Here we frame this frontier by conceptually developing a spatial decision-support tool that shows where, how, and for whom urban nature promotes physical activity, to inform urban greening efforts and broader health assessments. We synthesize what is known, present a model framework, and detail the model steps and data needs that can yield generalizable spatial models and an effective tool for assessing the urban nature–physical activity relationship. Current knowledge supports an initial model that can distinguish broad trends and enrich urban planning, spatial policy, and public health decisions. New, iterative research and application will reveal the importance of different types of urban nature, the different subpopulations who will benefit from it, and nature’s potential contribution to creating more equitable, green, livable cities with active inhabitants.
Read moreNature Versus Urban Hiking for Veterans with Post-Traumatic Stress Disorder: A Pilot Randomized Trial Conducted in the Pacific Northwest USA
Figure 1. Conceptual model Objectives To evaluate feasibility and acceptability of a group-based nature recreation intervention (nature hiking) and control condition (urban hiking) for military Veterans with post-traumatic stress disorder (PTSD). Design and setting A pilot randomised controlled trial conducted in the US Pacific Northwest. Participants Veterans with PTSD due to any cause. Interventions Twenty-six participants were randomised to a 12-week intervention involving either six nature hikes (n=13) or six urban hikes (n=13). Primary and Secondary Outcome Measures Feasibility was assessed based on recruitment, retention and attendance. Questionnaires and post-intervention qualitative interviews were conducted to explore intervention acceptability. Questionnaires assessing acceptability and outcomes planned for the future trial (eg, PTSD symptoms) were collected at baseline, 6 weeks, 12 weeks (immediately after the final hike) and 24 weeks follow-up. Results Of 415 people assessed for eligibility/interest, 97 were interested and passed preliminary eligibility screening, and 26 were randomised. Mean completion of all questionnaires was 91% among those in the nature hiking group and 68% in those in the urban hiking group. Over the course of the intervention, participants in the nature and urban groups attended an average of 56% and 58%, respectively, of scheduled hikes. Acceptability of both urban and nature hikes was high; over 70% reported a positive rating (ie, good/excellent) for the study communication, as well as hike locations, distance and pace. Median PTSD symptom scores (PTSD Checklist-5) improved more at 12 weeks and 24 weeks among those in the nature versus urban hiking group. Conclusions This pilot study largely confirmed the feasibility and acceptability of nature hiking as a potential treatment for Veterans with PTSD. Adaptations will be needed to improve recruitment and increase hike attendance for a future randomised controlled trial to effectively test and isolate the ways in which nature contact, physical activity and social support conferred by the group impact outcomes. Trial Registration Number NCT03997344
Read morePlanetary Health: Safeguarding the Environment and Human Health in the Anthropocene
We live in unprecedented times – the Anthropocene – defined by far-reaching human impacts on the natural systems that underpin civilisation. Planetary Health explores the many environmental changes that threaten to undermine progress in human health, and explains how these changes affect health outcomes, from pandemics to infectious diseases to mental health, from chronic diseases to injuries. It shows how people can adapt to those changes that are now unavoidable, through actions that both improve health and safeguard the environment. But humanity must do more than just adapt: we need transformative changes across many sectors – energy, housing, transport, food, and health care. The book discusses specific policies, technologies, and interventions to achieve the change required, and explains how these can be implemented. It presents the evidence, builds hope in our common future, and aims to motivate action by everyone, from the general public to policymakers to health practitioners.
Read moreThe COVID-19 Pandemic and Global Environmental Change: Emerging Research Needs
Figure 1. COVID-19 and Environment, Climate and Health. The figure shows the different stages of the pandemic development and, at each stage, the environmental factors that either contribute to or are impacted by that particular stage. The HERA consortium has made proposals for multidisciplinary research to achieve transformational change supporting and merging different agendas such as zero pollution, climate change resilience and mitigation, farm to fork, circular economy, EU chemical strategy for sustainability. These proposals can be found online. The outbreak of COVID-19 raised numerous questions on the interactions between the occurrence of new infections, the environment, climate and health. The European Union requested the H2020 HERA project which aims at setting priorities in research on environment, climate and health, to identify relevant research needs regarding Covid-19. The emergence and spread of SARS-CoV-2 appears to be related to urbanization, habitat destruction, live animal trade, intensive livestock farming and global travel. The contribution of climate and air pollution requires additional studies. Importantly, the severity of COVID-19 depends on the interactions between the viral infection, ageing and chronic diseases such as metabolic, respiratory and cardiovascular diseases and obesity which are themselves influenced by environmental stressors. The mechanisms of these interactions deserve additional scrutiny. Both the pandemic and the social response to the disease have elicited an array of behavioural and societal changes that may remain long after the pandemic and that may have long term health effects including on mental health. Recovery plans are currently being discussed or implemented and the environmental and health impacts of those plans are not clearly foreseen. Clearly, COVID-19 will have a long-lasting impact on the environmental health field and will open new research perspectives and policy needs.
Read moreThe Planetary Wellbeing Initiative: Pursuing the Sustainable Development Goals in Higher Education
We live in a time of pressing planetary challenges, many of which threaten catastrophic change to the natural environment and require massive and novel coordinated scientific and societal efforts on an unprecedented scale. Universities and other academic institutions have the opportunity and responsibility to assume a leading role in an era when the destiny of the planet is precisely in the hands of human beings. Drawing on the Planetary Health project promoted by the Rockefeller Foundation and The Lancet, Pompeu Fabra University launched in 2018 the Planetary Wellbeing Initiative, a long-term institutional strategy also animated by the United Nations Sustainable Development Goals (SDGs). Planetary Wellbeing might be defined as the highest attainable standard of wellbeing for human and non-human beings and their social and natural systems. Developing the potential of these new concepts involves a substantial theoretical and empirical effort in many different fields, all of them interrelated by the crosscutting challenges of global complexity, interdisciplinarity, and urgency. Close collaboration of science, humanities, and culture is more desperately needed now than ever before in the history of humankind.
Read morePlanetary Health: Protecting Nature to Protect Ourselves
Human health depends on the health of the planet. Earth’s natural systems—the air, the water, the biodiversity, the climate—are our life support systems. Yet climate change, biodiversity loss, scarcity of land and freshwater, pollution and other threats are degrading these systems. The emerging field of planetary health aims to understand how these changes threaten our health and how to protect ourselves and the rest of the biosphere. Planetary Health: Protecting Nature to Protect Ourselves provides a readable introduction to this new paradigm. With an interdisciplinary approach, the book addresses a wide range of health impacts felt in the Anthropocene, including food and nutrition, infectious disease, non-communicable disease, dislocation and conflict, and mental health. It also presents strategies to combat environmental changes and its ill-effects, such as controlling toxic exposures, investing in clean energy, improving urban design, and more. Chapters are authored by widely recognized experts. The result is a comprehensive and optimistic overview of a growing field that is being adopted by researchers and universities around the world. Students of public health will gain a solid grounding in the new challenges their profession must confront, while those in the environmental sciences, agriculture, the design professions, and other fields will become familiar with the human consequences of planetary changes. Understanding how our changing environment affects our health is increasingly critical to a variety of disciplines and professions. Planetary Health is the definitive guide to this vital field.
Read moreProtecting Health in Dry Cities: Considerations for Policy Makers
Water has always been essential for cities to survive and thrive. The earliest cities, from 4000 BC, were founded near water sources. Conversely, water scarcity might have contributed to the demise of ancient cities such as Tikal in present day Guatemala and Angkor in present day Cambodia. Water deprivation was also used as a weapon in ancient times; when Sennacherib of Assyria ransacked Babylon in 689 BC, he destroyed the city’s water supply. Dry cities present complex challenges in a dynamic world. The supply of water in many cities will increasingly fall short of demand, with diverse and potentially severe effects on health. In a world of pervasive inequalities, water scarcity is likely to hit the most vulnerable hardest. The challenge of achieving health in dry cities is intensified in the setting of resource scarcity, state and societal fragility, and weak institutions. The inter-relation between human health and the environment needs to be central to planning and management of both water and health systems. Promoting health and wellbeing in dry cities is essential to achieving the sustainable development goals. Innovation will be key to progress; it requires foresight, strong institutions, and action from many people. Today’s global population is increasingly urban, and the world is increasingly hot, with dry regions becoming drier. Dry cities have scarce water relative to demand. An estimated 150 million people live in cities that have perennial water shortage. Some cities are dry because of their location in arid environments, with low levels of fresh water, precipitation, or both. In the year 2000 about 27% of the world’s urban area was in drylands. Many of the world’s most water stressed countries are in the Middle East and North Africa. Doha, Abu Dhabi, and Dubai in the Gulf region, and desert cities, including Cairo (Egypt) and Windhoek (Namibia), Antofagasta (Chile), Trujillo (Peru), Phoenix, and Las Vegas (United States) are widely recognized as “dry cities.” Other cities are dry because of a temporary scarcity of water, or drought, influenced by factors including local hydrology, climate, and human activities. Semi-arid regions may have dry cities if drought strikes, if demand grows much faster than supply and/or if the city cannot keep pace owing to poor governance or inadequate infrastructure. Such cities include Cape Town (South Africa) and Gaborone (Botswana). Other cities, such as São Paulo (Brazil) and Chennai (India), historically have had ample water supply, but have recently confronted scarcity. Still others, such as Los Angeles (US) and Bangalore (India), are forecast to become short of water in coming years.
Read moreSustaining Life: Human Health–Planetary Health Linkages
Our beautiful planet has been profoundly altered by human activities. Climate change, biodiversity loss, pollution, land use changes, and disrupted cycles of water, nitrogen, and phosphorus, to name several alterations, in turn have far-reaching impacts on human health, especially targeting the most vulnerable. Planetary Health approaches the health of people and the health of the planet as inextricably linked. This chapter introduces the Planetary Health framework by exploring four examples: climate change, chemical contamination, land use changes, and biodiversity loss. It concludes by considering innovative ways of thinking, and novel ethical considerations, raised by the current crisis of planetary degradation.
Read moreIllnesses and Injuries at Nature Preschools
A binder with a larger version of the log shown above, with spacing set for eight children on each page, was provided to preschool teachers participating in this study. The log was created to enable teachers to systematically and easily record absences due to illness and injuries occurring during the preschool day. All preschool teachers received a 15 to 20 min training on how to use the log prior to the start of the study. Nature preschools, where children spend the entire school day outdoors, are increasingly popular, but their health consequences have not been well researched. This study tested the hypothesis that nature preschools and conventional preschools differ in their illness and injury incidence, by comparing observed illness and injury occurrence in the two types of schools. For 14 weeks, teachers at five nature preschools and four conventional preschools in Seattle, Washington logged absences due to illness. Two nature preschools and three conventional preschools also logged injuries that occurred during the school day. There was no difference in illness incidence by preschool type, and no serious injuries were reported in either setting. Overall, the study found that nature preschools are a healthy and safe child-care model.
Read moreManaged Retreat as a Strategy for Climate Change Adaptation in Small Communities: Public Health Implications
Table 1. Characteristics of selected case studies of managed retreat in small communities In coming decades, sea level rise associated with climate change will make some communities uninhabitable. Managed retreat, or planned relocation, is a proactive response prior to catastrophic necessity. Managed retreat has disruptive health, sociocultural, and economic impacts on communities that relocate. Health impacts include mental health, social capital, food security, water supply, sanitation, infectious diseases, injury, and health care access. We searched peer-reviewed and gray literature for reports on small island or coastal communities at various stages of relocation primarily due to sea level rise. We reviewed these reports to identify public health impacts and barriers to relocation. We identified eight relevant small communities in the USA (Alaska, Louisiana, and Washington), Panama, Fiji, Papua New Guinea, Solomon Islands, and Vanuatu. Affected populations range from 60 to 2700 persons and are predominantly indigenous people who rely on subsistence fishing and agriculture. Few reports directly addressed public health issues. While some relocations were successful, barriers to relocation in other communities include place attachment, potential loss of livelihoods, and lack of funding, suitable land, community consensus, and governance procedures. Further research is needed on the health impacts of managed retreat and how to facilitate population resilience. Studies could include surveillance of health indicators before and after communities relocate due to sea level rise, drought, or other environmental hazards. Lessons learned may inform relocation of both small and large communities affected by climate change.
Read moreNature and Mental Health: An Ecosystem Service Perspective
Figure 1. A conceptual model for mental health as an ecosystem service. A growing body of empirical evidence is revealing the value of nature experience for mental health. With rapid urbanization and declines in human contact with nature globally, crucial decisions must be made about how to preserve and enhance opportunities for nature experience. Here, we first provide points of consensus across the natural, social, and health sciences on the impacts of nature experience on cognitive functioning, emotional well-being, and other dimensions of mental health. We then show how ecosystem service assessments can be expanded to include mental health, and provide a heuristic, conceptual model for doing so.
Read moreBuilding Healthy Community Environments: A Public Health Approach
A framework for improving community health through better environment decision making. The current state presents baseline health and defines built environmental challenges. The desired state presents public health and environmental goals for a healthy community. The core components of the public health approach are shown indicating the path toward the desired state. Adapted from the World Health Organization. Bulleted items may differ for various communities and applications. Environmental quality has a profound effect on health and the burden of disease. In the United States, the environment-related burden of disease is increasingly dominated by chronic diseases. At the local level, public health practitioners realize that many policy decisions affecting environmental quality and health transcend the authorities of traditional health department programs. Healthy decisions about the built environment, including housing, transportation, and energy, require broad collaborative efforts. Environmental health professionals have an opportunity to address the shift in public health burden toward chronic diseases and play an important role in the design of healthy communities by bringing data and tools to decision makers. This article provides a guide for community leaders to consider the public health effects of decisions about the built environment. We present a conceptual framework that represents a shift from compartmentalized solutions toward an inclusive systems approach that encourages partnership across disciplines and sectors. We discuss practical tools to assist with environmental decision making, such as Health Impact Assessments, environmental public health tracking, and cumulative risk assessment. We also identify priorities in research, practice, and education to advance the role of public health in decision making to improve health, such as the Health Impact Assessment, as a core competency for environmental health practitioners. We encourage cross-disciplinary communication, research, and education that bring the fields of planning, transportation, and energy in closer collaboration with public health to jointly advance the systems approach to today’s environmental challenges.
Read moreNature Contact and Human Health: A Research Agenda
Figure 1. A spectrum of forms of nature contact. Background At a time of increasing disconnectedness from nature, scientific interest in the potential health benefits of nature contact has grown. Research in recent decades has yielded substantial evidence, but large gaps remain in our understanding. Objectives We propose a research agenda on nature contact and health, identifying principal domains of research and key questions that, if answered, would provide the basis for evidence-based public health interventions. Discussion We identify research questions in seven domains: a) mechanistic biomedical studies; b) exposure science; c) epidemiology of health benefits; d) diversity and equity considerations; e) technological nature; f) economic and policy studies; and g) implementation science. Conclusions Nature contact may offer a range of human health benefits. Although much evidence is already available, much remains unknown. A robust research effort, guided by a focus on key unanswered questions, has the potential to yield high-impact, consequential public health insights.
Read moreSafeguarding Human Health in the Anthropocene Epoch
Figure 1: Services provided by natural systems. Adapted from the Millennium Ecosystem Assessment. Far-reaching changes to the structure and function of the Earth’s natural systems represent a growing threat to human health. And yet, global health has mainly improved as these changes have gathered pace. What is the explanation? As a Commission, we are deeply concerned that the explanation is straightforward and sobering: we have been mortgaging the health of future generations to realise economic and development gains in the present. By unsustainably exploiting nature’s resources, human civilisation has flourished but now risks substantial health effects from the degradation of nature’s life support systems in the future. Health effects from changes to the environment including climatic change, ocean acidification, land degradation, water scarcity, overexploitation of fisheries, and biodiversity loss pose serious challenges to the global health gains of the past several decades and are likely to become increasingly dominant during the second half of this century and beyond. These striking trends are driven by highly inequitable, inefficient, and unsustainable patterns of resource consumption and technological development, together with population growth. We identify three categories of challenges that have to be addressed to maintain and enhance human health in the face of increasingly harmful environmental trends. Firstly, conceptual and empathy failures (imagination challenges), such as an over-reliance on gross domestic product as a measure of human progress, the failure to account for future health and environmental harms over present day gains, and the disproportionate effect of those harms on the poor and those in developing nations. Secondly, knowledge failures (research and information challenges), such as failure to address social and environmental drivers of ill health, a historical scarcity of transdisciplinary research and funding, together with an unwillingness or inability to deal with uncertainty within decision making frameworks. Thirdly, implementation failures (governance challenges), such as how governments and institutions delay recognition and responses to threats, especially when faced with uncertainties, pooled common resources, and time lags between action and effect. Although better evidence is needed to underpin appropriate policies than is available at present, this should not be used as an excuse for inaction. Substantial potential exists to link action to reduce environmental damage with improved health outcomes for nations at all levels of economic development. This Commission identifies opportunities for action by six key constituencies: health professionals, research funders and the academic community, the UN and Bretton Woods bodies, governments, investors and corporate reporting bodies, and civil society organisations. Although better evidence is needed to underpin appropriate policies than is available at present, this should not be used as an excuse for inaction. Substantial potential exists to link action to reduce environmental damage with improved health outcomes for nations at all levels of economic development. This Commission identifies opportunities for action by six key constituencies: health professionals, research funders and the academic community, the UN and Bretton Woods bodies, governments, investors and corporate reporting bodies, and civil society organisations. Depreciation of natural capital and nature’s subsidy should be accounted for so that economy and nature are not falsely separated. Policies should balance social progress, environmental sustainability, and the economy. To support a world population of 9–10 billion people or more, resilient food and agricultural systems are needed to address both undernutrition and overnutrition, reduce waste, diversify diets, and minimise environmental damage. Meeting the need for modern family planning can improve health in the short term—eg, from reduced maternal mortality and reduced pressures on the environment and on infrastructure. Planetary health offers an unprecedented opportunity for advocacy of global and national reforms of taxes and subsidies for many sectors of the economy, including energy, agriculture, water, fisheries, and health. Regional trade treaties should act to further incorporate the protection of health in the near and long term. Several essential steps need to be taken to transform the economy to support planetary health. These steps include a reduction of waste through the creation of products that are more durable and require less energy and materials to manufacture than those often produced at present; the incentivisation of recycling, reuse, and repair; and the substitution of hazardous materials with safer alternatives. Despite present limitations, the Sustainable Development Goals provide a great opportunity to integrate health and sustainability through the judicious selection of relevant indicators relevant to human wellbeing, the enabling infrastructure for development, and the supporting natural systems, together with the need for strong governance. The landscape, ecosystems, and the biodiversity they contain can be managed to protect natural systems, and indirectly, reduce human disease risk. Intact and restored ecosystems can contribute to resilience (see panel 1 for glossary of terms used in this report), for example, through improved coastal protection (eg, through wave attenuation) and the ability of floodplains and greening of river catchments to protect from river flooding events by diverting and holding excess water. The growth in urban populations emphasises the importance of policies to improve health and the urban environment, such as through reduced air pollution, increased physical activity, provision of green space, and urban planning to prevent sprawl and decrease the magnitude of urban heat islands. Transdisciplinary research activities and capacity need substantial and urgent expansion. Present research limitations should not delay action. In situations where technology and knowledge can deliver win–win solutions and co-benefits, rapid scale-up can be achieved if researchers move ahead and assess the implementation of potential solutions. Recent scientific investments towards understanding non-linear state shifts in ecosystems are very important, but in the absence of improved understanding and predictability of such changes, efforts to improve resilience for human health and adaptation strategies remain a priority. The creation of integrated surveillance systems that collect rigorous health, socioeconomic, and environmental data for defined populations over long time periods can provide early detection of emerging disease outbreaks or changes in nutrition and non-communicable disease burden. The improvement of risk communication to policy makers and the public and the support of policy makers to make evidence-informed decisions can be helped by an increased capacity to do systematic reviews and the provision of rigorous policy briefs. Health professionals have an essential role in the achievement of planetary health: working across sectors to integrate policies that advance health and environmental sustainability, tackling health inequities, reducing the environmental impacts of health systems, and increasing the resilience of health systems and populations to environmental change. Humanity can be stewarded successfully through the 21st century by addressing the unacceptable inequities in health and wealth within the environmental limits of the Earth, but this will require the generation of new knowledge, implementation of wise policies, decisive action, and inspirational leadership.
Read moreNature and Health
Figure 1: Some pathways through which the natural environment can affect the health of broad segments of populations. Urbanization, resource exploitation, and lifestyle changes have diminished possibilities for human contact with nature in many societies. Concern about the loss has helped motivate research on the health benefits of contact with nature. Reviewing that research here, we focus on nature as represented by aspects of the physical environment relevant to planning, design, and policy measures that serve broad segments of urbanized societies. We discuss difficulties in defining “nature” and reasons for the current expansion of the research field, and we assess available reviews. We then consider research on pathways between nature and health involving air quality, physical activity, social cohesion, and stress reduction. Finally, we discuss methodological issues and priorities for future research. The extant research does describe an array of benefits of contact with nature, and evidence regarding some benefits is strong; however, some findings indicate caution is needed in applying beliefs about those benefits, and substantial gaps in knowledge remain.
Read moreBeyond Toxicity: Human Health and the Natural Environment
Research and teaching in environmental health have centered on the hazardous effects of various environmental exposures, such as toxic chemicals, radiation, and biological and physical agents. However, some kinds of environmental exposures may have positive health effects. According to E.O. Wilson’s “biophilia” hypothesis, humans are innately attracted to other living organisms. Later authors have expanded this concept to suggest that humans have an innate bond with nature more generally. This implies that certain kinds of contact with the natural world may benefit health. Evidence supporting this hypothesis is presented from four aspects of the natural world: animals, plants, landscapes, and wilderness. Finally, the implications of this hypothesis for a broader agenda for environmental health, encompassing not only toxic outcomes but also salutary ones, are discussed. This agenda implies research on a range of potentially healthful environmental exposures, collaboration among professionals in a range of disciplines from public health to landscape architecture to city planning, and interventions based on research outcomes.
Read moreCOVID-19, the Built Environment, and Health
Figure 1. Milan’s lazaretto, built just outside the city’s walls in the late 15th and early 16th centuries to house plague victims. Having outlived its usefulness, it was demolished about 400 y later. This part of Milan, Porta Venezia, is now a vibrant neighborhood of galleries and ethnic restaurants—or it was until COVID-19 struck. Source: Wikimedia Background Since the dawn of cities, the built environment has both affected infectious disease transmission and evolved in response to infectious diseases. COVID-19 illustrates both dynamics. The pandemic presented an opportunity to implement health promotion and disease prevention strategies in numerous elements of the built environment. Objectives This commentary aims to identify features of the built environment that affect the risk of COVID-19 as well as to identify elements of the pandemic response with implications for the built environment (and, therefore, for long-term public health). Discussion Built environment risk factors for COVID-19 transmission include crowding, poverty, and racism (as they manifest in housing and neighborhood features), poor indoor air circulation, and ambient air pollution. Potential long-term implications of COVID-19 for the built environment include changes in building design, increased teleworking, reconfigured streets, changing modes of travel, provision of parks and greenspace, and population shifts out of urban centers. Although it is too early to predict with confidence which of these responses may persist, identifying and monitoring them can help health professionals, architects, urban planners, and decision makers, as well as members of the public, optimize healthy built environments during and after recovery from the pandemic.
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