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This research paper examines the relationships between human populations and the natural and physical environment. Because of the coupled relationships between human health and the environment, global institutions such as the World Health Organization have intervened to prevent infectious and noncommunicable diseases by attending to their social and ecological determinants. It is generally accepted that human health depends upon a sustainable environment that provides opportunities for healthy decision-making and effective disease management. Multiple scholarly disciplines attend to health and environment interactions, including the fields of environmental health, social epidemiology, medical geography, and political ecology. Additionally, activists and policy-makers have received international attention by showing how human health is affected through disproportionate exposure to positives and negatives within the surrounding environment. Whether this means proximity to facilities that produce toxins and pollutants or access to green space and bikeways that promote healthy lifestyles, these factors have contributed to the linking of health with concerns for social and environmental justice.
- Environmental Health
- Climate Change and Health
- Political Economy and Environmental Health
- Health within Changing Environments
- Environmental Justice
Human health is intricately connected to the environment. This recognition includes the natural environment and a range of biotic and abiotic factors, as well as the physical or human-built environment that facilitates the spread of infectious disease or the production of conditions that influence noninfectious, or noncommunicable, disease. As one example, malaria is transmitted by Anopheles mosquitoes that serve as the main vector for human populations. These mosquitoes are highly dependent upon the natural environment, specifically in terms of precipitation and temperature that can alter the environmental conditions that allow for their survival. Recent work has shown that daily fluctuations in temperature affect parasite infection, the rate of parasite development, and components of mosquito biology that combine to determine the intensity of malaria transmission (Paaijmans et al., 2010). Daily temperature changes have also been shown to play a role in dengue virus transmission by the Aedes aegypti mosquito (Lambrechts et al., 2011). Specifically, mosquito life span and susceptibility to dengue infection decreases when there are larger fluctuations in daily temperature as compared to only moderate daily temperature variations. The implication is that human and nonhuman species are directly impacted by the natural environment. Additionally, these coupled relationships are dynamic and can shift because of variations in temperature, precipitation, or ecosystem functioning.
Other infectious diseases with an unknown etiology are credited with being produced by the natural environment. The pathogen Mycobacterium ulcerans is the causal agent for Buruli ulcer disease, which is one of the most frequently occurring human mycobacterial diseases (Qi et al., 2013). Ongoing research is working to show how anthropogenic impacts on the natural environment, particularly land cover disturbance and climate change, could trigger human exposure to the pathogen. In addition to the ecological patterns, Buruli ulcer is also potentially involved with social systems such as livelihood production and settlement patterns. These three examples of malaria, dengue fever, and Buruli ulcer disease show that the transmission of infectious disease to human beings is related to nonhuman species, temperature, precipitation, and other drivers within the surrounding environment.
International agencies emphasize the role of the natural and physical environment in producing hazards such as those caused by unsafe drinking water or exposure to toxins and air pollutants. According to the World Health Organization, within developing countries, the primary environmentally caused diseases are diarrheal disease, lower respiratory infections, unintentional injuries and accidents, and malaria. Within wealthier and industrialized countries, cancer, cardiovascular disease, asthma, lower respiratory infections, and traffic injuries are major health hazards. According to the World Health Organization Public Health & Environment Global Strategy Overview (2011), environmental hazards are responsible for roughly a quarter of the total burden of global disease. In developing countries, the burden of environmental hazards is more strongly experienced by communicable diseases, such as malaria, dengue fever, and human immunodeficiency virus (HIV). In developed countries, environmental hazards are believed to have a larger impact upon noncommunicable diseases.
The central areas of emphasis for the World Health Organization in dealing with public health and the environment include improvements in water, sanitation, and hygiene to prevent waterborne diseases such as cholera. Indoor air pollution deriving from fuels and cook stoves, in addition to outdoor air pollution resulting from urban transportation and population growth, are also emphasized as requiring intervention and policy responses. Lastly, the World Health Organization notes the need for chemical regulation policies that reduce exposure from industrial and agricultural activities (World Health Organization, 2011). These types of environmental health dynamics attest to the role of unsustainable development practices in making certain populations vulnerable to illness.
The United Nations has recently emphasized the role of noncommunicable human diseases as the primary cause of death and disability in the world. Roughly two-thirds of annual deaths are caused by cardiovascular diseases, cancers, chronic respiratory diseases, and diabetes. Because many of these can be prevented, public health experts emphasize the importance of reducing tobacco use and alcohol, unhealthy diets, and a lack of exercise. In terms of noncommunicable disease, there are a variety of behavioral and physical environmental conditions that support their expansion. There has been a growth of popularly written books that link the relationships between food production and consumption patterns with human wellbeing. Michael Pollan (2006), Eric Schlosser (2001), and Marian Nestle (2006) have received attention for suggesting that changes to food decision-making are needed to reduce obesity, dependence upon pesticides and oil, and support local economies and environmental systems. Central to this argument is that industrialized food production in the United States, particularly the dependence upon corn, has triggered infrastructure and cultural shifts that have repercussions for human health.
A number of academic and policy fields study health and environment interactions with the intention of detailing effective interventions to ensure sustainable and viable possibilities for human well-being. Infectious diseases are connected to the natural environment and changes to global climate dynamics. The field of environmental health examines how human health is affected by the natural and physical environment. The disciplines of environmental epidemiology, toxicology, and exposure science are often recognized as central to environmental health. Environmental epidemiology studies the relationship between environmental exposures, such as chemicals, radiation, microbiological agents, and human health. Toxicology studies show how these exposures lead to specific health outcomes. Finally, exposure science examines human exposure to environmental contaminants by both identifying and quantifying exposures. In addition to these research fields, social science disciplines, such as social epidemiology, medical anthropology, and public health, have been influential in showing the specific connections between the natural environment and human health. The World Health Organization (2014) defines environmental health as the “physical, chemical, and biological factors external to a person, and all the related factors impacting behaviours. It encompasses the assessment and control of those environmental factors that can potentially affect health. It is targeted towards preventing disease and creating health-supportive environments. This definition excludes behaviour not related to environment, as well as behaviour related to the social and cultural environment, and genetics.”
The field of epidemiology is also credited with making connections between human health and the surrounding environment. The work of Dr John Snow is widely recognized as advancing the science of germ theory through the identification of the cause of a cholera outbreak in Soho, England, in 1854. Snow mapped the incidence of the outbreak and interviewed local residents to identify the source as a water pump on Broad Street. The dismantling of the pump and subsequent cessation of the outbreak helped establish epidemiology as the foundation for public health while evidencing the relationships between the environment and human health.
The built environment is integral to human health. Within the United States, the expansion of the suburbs following World War II necessitated transportation to allow individuals to travel to employment and commercial centers. This transportation was largely the automobile with one consequence being an increasingly sedentary lifestyle that is credited with contributing to health challenges, such as obesity. Urbanization is also occurring on the global scale, with more than half of the world’s population now residing in an urban area. The World Health Organization (2011) estimates that by 2050, 70% of the world’s population will be living in towns and cities. While potentially increasing access to health care services and environmental benefits, in a public health bulletin the World Health Organization notes that urbanization could concentrate health risks while generating new hazards. Globally, road traffic injuries are the ninth leading cause of death, and most road traffic deaths occur in low- and middle-income countries. Urban air pollution kills around 1.2 million people globally each year, primarily due to cardiovascular and respiratory diseases. A significant proportion of urban air pollution is caused by motor vehicles, although industrial pollution, electricity generation, and in least developed countries, household fuel combustion are also major sources. Infectious disease, such as tuberculosis, can concentrate in large urban centers. In New York City, tuberculosis incidence is four times the national average. In the Democratic Republic of the Congo, 83% of people with tuberculosis live in cities. Lastly, the World Health Organization notes that urban environments are not always designed to support physical activity or promote healthy food consumption. Participation in physical activity is constrained by a variety of urban factors including overcrowding, high-volume traffic, heavy use of motorized transportation, poor air quality, and lack of safe public spaces and recreation facilities.
Another potential health effect with increasing urbanization is heat stress. Wilhelmi et al. (2013) assert that the urban heat island (UHI) effect is a leading cause of weather-related mortality in the United States and elsewhere. Different groups within the population are more vulnerable, specifically the young and elderly, and also those without access to air conditioning or other services that could mitigate the effects. It is anticipated that urban heat stress will intensify in the future with global climate change and an increasingly urbanized population.
While the global population increasingly urbanizes, there are still rural populations whose health and quality of life depend upon services that are not always available. In fact, one of the motivations for migration to urban environments is to seek out employment and social services that can positively influence human health. Within rural communities in the United States, there exist variations in proximity and ability to access health care centers, such as clinics or hospitals. One response has been the establishment of mobile clinics that extend the range of services for these populations.
Climate Change and Health
Anthropogenic climate change represents a significant challenge for the natural environment and human health. Variations in the amount, intensity, and duration of precipitation can alter the environmental conditions that allow certain disease vectors to survive. Additionally, temperature changes can shift the latitudes for ecosystems to support the movement of species into new areas. The Intergovernmental Panel on Climate Change (IPCC) Fifth Assessment Report (Smith et al., 2014) includes a chapter that addresses the links between global climate change and human health. The IPCC recognizes three pathways through which climate change affects health. The first pathway includes direct impacts that are tied to changes in the frequency of extreme weather including heat, drought, and heavy rain. The second pathway considers effects mediated through natural systems such as the role of disease vectors, water-borne diseases, and air pollution. As evidence of these effects, the report acknowledges that the spread of malaria in parts of Africa, or the West Nile Virus in the United States, demonstrates how infectious disease can accompany changing weather patterns. Lastly, the third pathway addresses effects heavily mediated by human systems, such as occupational impacts, undernutrition, and mental stress.
Climate change and health scenarios within the IPCC report suggest that there will be greater risk of injury, disease, and death due to more intense heat waves and fires. The report notes with high confidence that there will be increased risk of undernutrition stemming from reductions in food productivity and increased risks of food and waterborne disease and vector-borne diseases. The IPCC report also recognizes the social dynamics influenced by climate change that shape human health. Human populations could be disrupted due to rising sea levels, reduced access to environmental services, and agricultural decline. The report notes that until the mid-century climate change will most likely intensify existing health challenges in ways that affect the most vulnerable. The most vulnerable populations will likely have reduced work capacity and less productivity, which can cause a downward spiral into increased socioeconomic poverty. As such, the IPCC recommends addressing underlying social vulnerabilities to environmental change by investing in policies to increase access to clean water and sanitation, improve health care services including vaccination and child health services, reduce socioeconomic poverty, and improve the ability of populations to respond to disasters. The achievement of these goals will require substantial planning given that the IPCC recommends redesigning transport systems to promote active transport and reduce dependency upon motorized vehicles.
Political Economy and Environmental Health
Because health and environment interactions are mediated by social systems, the role of political, economic, cultural, and gendered dynamics in shaping health vulnerabilities and environmental sustainability have been addressed by a number of academic disciplines. The field of social epidemiology has demonstrated the social determinants of health and how these vary within settings. Medical anthropology has made a number of contributions on health and the built environment with one widely recognized element being how variations in access to disease and quality health care constitute structural violence against a population (Farmer, 1999). The field of medical geography has drawn upon disease ecology to examine how the natural environment, including features such as topography, vegetation, and climate, interact with vector and pathogen ecology to produce disease. These fields have been valuable in showing the role of social and ecological determinants in shaping human health and the ways that vulnerabilities vary across spatial and temporal scales.
Attending to the underlying conditions that contribute to the spread of infectious disease or facilitate noncommunicable conditions, scholarship has focused upon the structural and political economic dynamics that produce health inequalities. An early proponent of this approach was Meredith Turshen (1977: p. 48) who argued that disease ecology viewed economic and political processes to be irrelevant, and therefore suffered “from a failure to consider the relation of people to their environment in all its complexity.” Building upon this with an examination of health and environment interactions in Tanzania, Turshen (1984) utilized a political ecology of disease approach to assert that historical and spatial systems were integral to human health and well-being. Specifically, she argued that the imposition of colonialism upon Tanzania transformed social and environmental systems in fundamental ways that would have lasting effects following the country’s independence in 1962.
Within the social sciences, the research field of political ecology has documented the ways that political and economic systems shape environmental resource use and management. Political ecology has been identified as having five primary themes (Robbins, 2012), with one being the positioning of nonhuman actors into human systems to understand the resulting impacts for disease management. Political ecology has provided greater attention to environment and health interactions in recent years while drawing upon related scholarship from medical anthropology and health geography (King, 2010). Central to this wave of research is attending to the role of political and economic systems in producing disease vulnerabilities and differential health management capabilities. Disease discourses, including the meanings and practices that are inscribed within particular disease patterns, are also addressed by political ecology. Lastly, political ecologies of health also emphasize the coupled relationships between social and ecological systems in producing human health and well-being.
The reciprocal dynamics between social and ecological systems has been demonstrated with the HIV/AIDS epidemic. While research and policy have shown the ways in which the disease has impacted demographic patterns, national economies, and agricultural production, there are also ecological effects associated with the spread and management of HIV. Talman et al. (2013) identify a number of possible interactions between HIV and the natural environment, including the selling of livestock, land fragmentation, agricultural decline, and increased dependence upon natural resources as a coping mechanism. One of the emerging findings from current scholarship is the importance of food security in providing needed nutrition and vitamins to those infected with the HIV virus. In work from central Mozambique, Kalofonos (2010) shows that adherence to antiretroviral therapy is tightly coupled with food needs and intracommunity tensions about who receives external assistance. While international public health and development organizations deserve recognition for increasing access to life-saving medications, the gamut of needs involved with HIV management indicate multifaceted interactions with the natural environment.
An additional way in which changes in the natural environment and human health are coupled is through an understanding of coproduction between humans and nonhuman species. Rather than focusing upon a unidirectional set of relationships, coproduction evaluates the ways in which nonhuman nature influences social systems. Scholarship has addressed how interactions with nonhuman species, such as a mosquito, results in adjustments by humans to manage disease outbreaks and public sentiment. In a case study addressing the management of A. aegypti and Culex quinquefasciatus mosquitoes in the state of Arizona, it has been shown that concerns about West Nile Virus have prompted different state responses ranging from surveillance and adulticide, GIS monitoring and larvacide, and education and public awareness (Robbins and Miller, 2013). As another example of this coproduction, Scott et al. (2012) examined the relationships between humans and pathogens, which they suggest are mutually conditioned due to continuous changes in exposures and institutional processes.
Health within Changing Environments
The post-World War II period marked the onset of emerging environmental concerns and legislation that were significant for coupling environmental health with human health. Particularly notable were the contributions from Rachel Carson who raised public awareness about the human and environmental dangers from pesticides in industrial agriculture. In Silent Spring Carson used her scientific training to argue that chemicals were becoming widely used for controlling disease and pests. She argued that the reliance upon these pesticides within the industrial agriculture, in addition to practices such as single crop farming and imported species, made human and nonhuman species vulnerable. Carson focused her attention upon dichlorodiphenyltrichloroethane (DDT) which had been converted from a preventative for malaria and typhus among soldiers to an agricultural insecticide following the conclusion of the war. Among the species directly impacted by DDT were ospreys and bald eagles, whose ability to reproduce was negatively affected due to the concentration of the pesticide in the food chain. When the bald eagle was adopted as the nation’s symbol in 1782 there were 25 000–75 000 nesting pairs, however, by the early 1960s there were fewer than 450 pairs. The banning of DDT in 1972, coupled with the passage of the Endangered Species Act in 1973, is largely credited with the recovery of the bald eagle and other raptor populations.
In the wake of Carson’s warnings and the first United States Earth Day in 1970, major pieces of environmental legislation were passed to protect the health and sustainability of the natural environment. These include the National Wilderness Act (1964), the Wild and Scenic Rivers and National Trails Act (1968), the Clean Air Act (1963), the Clean Water Act (1972), and the Safe Drinking Water Act (1974). The consequence has been an expansion of traditional environmental protection in the United States for particular landscapes, such as the creation of Yellowstone National Park in 1872, toward policy engagements that couple the possibilities for human health with the sustainability of the natural environment.
The relationships between the environment and human health are not equally experienced. The rise of case studies that show the disproportionate exposure to environmental hazards, such as proximity to facilities that produce toxins or pollutants, have helped establish links between health and social and environmental justice. One of the first incidents that brought public attention to environmental hazards was the Love Canal incident. Love Canal is a community in upstate New York that was built over 21 000 tons of toxic waste that had been dumped by Occidental Petroleum Corporation, which was previously Hooker Chemical Company. Historic rainfall caused the improperly stored containers to leach into the basements of 100 homes and a public school. This rainfall generated widespread concern because the landfill was believed to contain 82 different compounds of which 11 were suspected carcinogens at the time, including benzene. Declared a federal disaster area, residents organized to receive assistance in relocating, which was a process that unfolded for several years. In addition to raising public awareness as to the potential health hazards from unregulated exposure to toxins, Love Canal provided the catalyst for the establishment of Superfund Legislation that empowers the Environmental Protection Agency (EPA) to list and remediate toxic waste sites.
Following Love Canal, two cases helped advance the argument that disproportionate exposure to landfills and pollutants should be considered environmental racism. The announcement in 1978 that a landfill to store polychlorinated biphenyls (PCBs) was to be placed in Warren County, North Carolina, provoked widespread community protests against the decision. The Afton community, which was slated to be directly affected by the creation of the landfill, was situated in a region of high socioeconomic poverty and contained a largely African American population. Community residents organized nonviolent protests and attempted to use the court system to overturn the decision; however, the landfill opened in 1982. The second case was the Whispering Pines Sanitary Landfill which was intended to be placed in a largely African American neighborhood in Houston, Texas. In writing about the case, Robert Bullard (2005) noted that although African Americans made up 25% of the city’s population at that time, the five city-owned landfills (100%) and six of the eight city-owned incinerators (75%) were in African American neighborhoods. Working with residents, Bullard and others at the Texas Southern University helped file a lawsuit to stop the landfill from opening. Bean v. Southwestern Management Corp. was the first lawsuit in the United States that charged environmental discrimination in the siting of a waste management facility. After several years in court it was ultimately unsuccessful, however, it helped set a precedent in using the Civil Rights Act to allege environmental racism.
The United States Environmental Protection Agency defines environmental justice as the “fair treatment and meaningful involvement of all people regardless of race, color, national origin, or income with respect to the development, implementation, and enforcement of environmental laws, regulations, and policies. EPA has this goal for all communities and persons across this Nation. It will be achieved when everyone enjoys the same degree of protection from environmental and health hazards and equal access to the decision-making process to have a healthy environment in which to live, learn, and work.” Since the signing of Executive Order 12898 in 1994, the federal government is charged with making environmental justice part of its regular operations. The mainstreaming of environmental justice in U.S. federal policy has not been seamless, but it does present an opportunity for agencies to address inequities in exposure to environmental hazards that contribute to reduced opportunities and poor health.
Environmental justice considers the relationships between health and the environment and also the variations that exist within settings. In conclusion, environmental justice is not simply a function of disproportionate exposure to hazards but it also examines inequitable access to characteristics in the natural and physical environment that contribute positively to human health. The idea of a food desert has become common in scholarly and activist communities in showing how, due to planning and political economic processes, certain areas can lack access to full service grocery stores that offer healthy produce. Within urban environments there can be variations in access to green space that provides opportunities for recreation and contemplation. The recognition of these types of inequities has expanded traditional understandings of environmental justice to address the underlying factors that shape variations in exposure to both the positive and negative elements contributing to human health and well-being.
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