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Environments should improve not harm our health

Dr Maria Neira, WHO Director, Department of Public Health, Environmental and Social Determinants of Health

Commentary
15 March 2016

In a refugee camp in Central America a young child rests in his mother’s arms. The outline of his ribs protrude from his chest with every breath. Chills cause his body to shake. The corners of his mouth are cracked from dehydration.

Dr Maria Neira, WHO Director, Department of Public Health, Environmental and Social Determinants of Health

Pneumonia – the single largest cause of death in children under 5 years of age and one of the most common environmental-related diseases – has infected his lungs. And, he’s not the only one.

This was a daily occurrence 25 years ago in the medical tent where I worked. Countless children with pneumonia and diarrhoeal diseases were brought in for treatment. As the camp’s doctor, I worked to treat every patient, but quickly realized medicine would never be enough.

Poor water, sanitation and hygiene, and indoor air pollution from burning wood for cooking and heating were causing the same illnesses over and over again. In order to prevent these diseases, the environment needed to change.

Hundreds of cities are now choked by pollution

Sadly, environmental risks, not only in refugee camps but in cities worldwide, are still causing millions of diseases and deaths every year.

According to WHO’s new estimates, 23% of all global deaths – an estimated 12.6 million every year – are linked to environment risks such as air, water and soil pollution, chemical exposures, climate change and ultraviolent radiation. Beyond pneumonia and diarrheal diseases, these risks contribute to more than 100 diseases and injuries.

As more people move to cities seeking better opportunities the problem is expected to continue. Today, more than 1 in 2 people live in cities. By 2050, this proportion is expected to grow to 2 in 3 people. Cities are not known as healthy places. Heavy traffic, limited green spaces, air pollution, noise and violence all deteriorate our health.

Some 8.2 million environmental-related deaths, nearly 67% of the total burden, are due to noncommunicable diseases (NCDs), such as stroke, heart disease, cancers and chronic respiratory diseases. These deaths are mostly caused by the air we breathe. Nearly every city worldwide is choked by air pollution.

In spite of this, most environmental-related deaths are preventable.

Tougher measures would save lives

Improvements in water and sanitation and clean cooking fuels, along with immunization and insecticide-treated mosquito nets, have already reduced infectious diseases like malaria and diarrhoea, that were once the top causes of environmental-related deaths.

Now, we need to take more measures to prevent NCDs.

At present, countries invest very little— on average only 3% of health expenditures – in primary prevention strategies such as building active transport networks favourable to walking and biking. If countries were to shift resources from treating diseases to preventing them, for example by reducing air pollution through stricter emissions standards, they would immediately see healthcare costs decrease – thanks to a reduction in emergency room visits during air pollution alerts.

"Beyond healthcare savings, many environmental interventions impact multiple diseases at once."

Dr Maria Neira, WHO Director, Department of Public Health, Environmental and Social Determinants of Health

Beyond healthcare savings, many environmental interventions impact multiple diseases at once. For example, if all low- and middle-income countries started using cleaner fuels for cooking, we would see reductions in acute respiratory infections, chronic respiratory diseases, cardiovascular diseases and burns at once. The same is true for transport interventions, and adequate water and sanitation.


Improvements need to impact everyone

Many cities in the world have already taken significant measures to protect the environment.

In 2011, the City of Cape Town, South Africa launched a new bus rapid transit system called MyCiti that connects to a network of cycling paths and upgraded walkways, making it possible to walk or cycle to a bus stop in an integrated fashion.

Through WHO’s Water Safety Plan, which works to identify and address threats to drinking-water safety, the water supplier in Manila, Philippines, worked with organizations to plant trees to protect watersheds.

Steps like these both reduce environmental risks and improve health. Now, we need more cities and more countries to get on board. Not only do we need more measures like this, we need to ensure all these measures benefit everyone, not just the rich or the poor.

As the world embarks on a new global development agenda with the UN Sustainable Development Goals, environmental health interventions can make a valuable and sustainable contribution towards reducing the global disease burden and improving the well-being of people everywhere.

We need to move beyond treating our patients, like those I treated in refugee camps years ago, to preventing diseases in the first place.

And, build an environment that improves rather than harms our health.