essay health and environment

January 28, 2011

The Link between the Environment and Our Health

Would people care more about the environment if they had a better understanding of how it affects them personally?

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Dear EarthTalk : Aren’t environmental issues primarily about health? Detractors like to trivialize environmentalists as “tree huggers,” but the bottom line is that pollution makes us sick, right? Wouldn’t people care more if they had a better understanding of that?— Tim Douglas, Stowe, Vt. No doubt many of the ways we harm our environment come back to haunt us in the form of sickness and death. The realization that the pesticide-laced foods we eat, the smokestack-befouled air we breathe and the petrochemical-based products we use negatively affect our quality of life is a big part of the reason so many people have “gone green” in recent years. Just following the news is enough to green anyone. Scientific American reported in 2009 that a joint U.S./Swedish study looking into the effects of household contaminants discovered that children who live in homes with vinyl floors—which can emit hazardous chemicals called phthalates—are twice as likely to develop signs of autism as kids in other homes. Other studies have shown that women exposed to high levels of polybrominated diphenyl ether (PBDE) flame retardants common in cushions, carpet padding and mattresses—97 percent of us have detectable levels of these chemicals in our bloodstreams—are more likely to have trouble getting pregnant and suffer from other fertility issues as a result. Cheaply produced drywall made in China can emit so much sulfur gas that it not only corrodes electrical wiring but also causes breathing problems, bloody noses and headaches for building occupants. The list goes on and on.... But perhaps trumping all of these examples is the potential disastrous health effects of global warming. Carbon dioxide emissions may not be directly responsible for health problems at or near their point of release, but in aggregate they can cause lots of distress. According to the Center for Health and the Global Environment at Harvard Medical School, climate change over the coming decades is likely to increase rates of allergies, asthma, heart disease and cancer, among other illnesses. Also, it is quite likely that, as global temperature rises, diseases that were previously found only in warmer areas of the world may show up increasingly in other, previously cooler areas, where people have not yet developed natural defenses against them. And the loss of rain forest that accompanies increases in temperature means less access to undiscovered medicines and degradation of the environment’s ability to sustain our species. Given the link between environmental problems and human health, more of us are realizing that what may seem like exorbitant up-front costs for environmental clean-up may well pay us dividends in the end when we see our overall health care costs go down and our loved ones living longer, healthier lives. To help bridge the understanding gap between environmental problems and human health, the nonprofit Environmental Health Sciences offers the free website, Environmental Health News , which features daily reports on research showing how man-made environmental problems correspond to a wide range of individual and public health problems. Even your local TV station or newspaper likely carries an occasional story about the health effects of environmental pollution. We don’t have to look very hard to find examples of environmental neglect leading to human suffering. But with newfound public awareness and the commitment of younger generations to a cleaner future, we are moving in a good direction. CONTACTS : Harvard Medical School Center for Health and the Global Environment, http://chge.med.harvard.edu ; Environmental Health News , www.environmentalhealthnews.org .

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Human Impacts on the Environment

Humans impact the physical environment in many ways: overpopulation, pollution, burning fossil fuels, and deforestation. Changes like these have triggered climate change, soil erosion, poor air quality, and undrinkable water. These negative impacts can affect human behavior and can prompt mass migrations or battles over clean water.

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Article contents

The environment in health and well-being.

• George Morris George Morris European Centre for Environment and Human Health, University of Exeter Medical School, Truro, United Kingdom
•  and  Patrick Saunders Patrick Saunders University of Staffordshire, University of Birmingham, and WHO Collaborating Centre
• https://doi.org/10.1093/acrefore/9780199389414.013.101
• Published online: 29 March 2017

Most people today readily accept that their health and disease are products of personal characteristics such as their age, gender, and genetic inheritance; the choices they make; and, of course, a complex array of factors operating at the level of society. Individuals frequently have little or no control over the cultural, economic, and social influences that shape their lives and their health and well-being. The environment that forms the physical context for their lives is one such influence and comprises the places where people live, learn work, play, and socialize, the air they breathe, and the food and water they consume. Interest in the physical environment as a component of human health goes back many thousands of years and when, around two and a half millennia ago, humans started to write down ideas about health, disease, and their determinants, many of these ideas centered on the physical environment.

The modern public health movement came into existence in the 19th century as a response to the dreadful unsanitary conditions endured by the urban poor of the Industrial Revolution. These conditions nurtured disease, dramatically shortening life. Thus, a public health movement that was ultimately to change the health and prosperity of millions of people across the world was launched on an “environmental conceptualization” of health. Yet, although the physical environment, especially in towns and cities, has changed dramatically in the 200 years since the Industrial Revolution, so too has our understanding of the relationship between the environment and human health and the importance we attach to it.

The decades immediately following World War II were distinguished by declining influence for public health as a discipline. Health and disease were increasingly “individualized”—a trend that served to further diminish interest in the environment, which was no longer seen as an important component in the health concerns of the day. Yet, as the 20th century wore on, a range of factors emerged to r-establish a belief in the environment as a key issue in the health of Western society. These included new toxic and infectious threats acting at the population level but also the renaissance of a “socioecological model” of public health that demanded a much richer and often more subtle understanding of how local surroundings might act to both improve and damage human health and well-being.

Yet, just as society has begun to shape a much more sophisticated response to reunite health with place and, with this, shape new policies to address complex contemporary challenges, such as obesity, diminished mental health, and well-being and inequities, a new challenge has emerged. In its simplest terms, human activity now seriously threatens the planetary processes and systems on which humankind depends for health and well-being and, ultimately, survival. Ecological public health—the need to build health and well-being, henceforth on ecological principles—may be seen as the society’s greatest 21st-century imperative. Success will involve nothing less than a fundamental rethink of the interplay between society, the economy, and the environment. Importantly, it will demand an environmental conceptualization of the public health as no less radical than the environmental conceptualization that launched modern public health in the 19th century, only now the challenge presents on a vastly extended temporal and spatial scale.

• environmental and human health
• environment
• environmental epidemiology
• environmental health inequalities
• ecological public health

Introduction

This article traces the development of ideas about the environment in human health and well-being over time. Our primary focus is the period since the early 19th century , sometimes termed the “modern public health era.” This has been not only a time of unprecedented scientific, technological, and societal transition but also a time during which perspectives on the relationship of humans to their environment, and its implications for their health and well-being, have undergone significant change.

Curiosity about the environment as a factor in human health and well-being, and indeed health-motivated interventions to manage the physical context for life, substantially predate the modern public health era. The archaeological record provides evidence of sewer lines, primitive toilets, and water-supply arrangements in settlements in Asia, the Middle East, South America, and Southern Europe, dating back many thousands of years (Rosen, 1993 ). Some religious traditions also imply recognition of the importance of environmental factors in health. For example, restrictions on the consumption of certain foods probably derive from a belief that these foods carried risks to health; a passage in the book of Leviticus conveys the existence of a belief in the relationship between the internal state of a house and the health of its occupants (Leviticus [14:33–45], quoted in Frumkin, 2005 ).

The sixty-two books of the “Hippocratic Corpus” dating from 430–330 bc are the accepted bedrock of Western medicine (Lloyd, 1983 ), not least because they departed from the purely supernatural explanations for health and disease which hitherto held sway. For the first time, ideas about medicine, diseases, and their causes were being written down. Among these were ideas about the environment and its relationship to mental and physical health (Lloyd, 1983 ; Rosen, 1993 ; Kessel, 2006 ). While scarcely a template for how societies would come to think about environment and health in the modern era, one Hippocratic text in particular, On Airs, Waters and Places , introduces several ideas that do retain currency. For example, the simple message that good health is unlikely to be achieved and maintained in poor environmental conditions is enduring. Also, through specific reference to the health relevance of changes in water, soil, vegetation, sunlight, winds, climate, and seasonality, On Airs, Waters and Places conceives an environment made up of distinct compartments and spatial scales from local to global, recognizing that perturbations in these compartments, and on these scales, may result in disease. Such thinking remains conceptually and operationally relevant today. Hazardous agents are still frequently addressed in “environmental compartments” such as water, soil, air, and food or by developing and applying environmental standards for the different categories of place where people work, live, learn, and socialize. In parts, the Hippocratic Corpus also presages the ecological perspectives now coloring 21st-century public health thinking. These include an understanding of the potential for human activity to impact negatively on the natural world and the importance of viewing the body within its environment as a composite whole.

Environment and Health in the Modern Public Health Era

Epidemiology is the basic science of public health and is concerned with the distribution of health and disease in populations across time and spaces, together with the determinants of that distribution. Environmental epidemiology is a subspecialty dealing with the effects of environmental exposures on health and disease, again, in populations. Since the early 19th century , the outputs of epidemiology have been key components of a “mixed economy of evidence” that has shaped and reshaped priorities and informed the decisions society takes to protect and improve population health (Petticrew et al., 2004 ; Baker & Nieuwenhuijsen, 2008 ).

In a classic paper from the 1990s, the respected epidemiologists, Mervyn and Ezra Susser, helpfully described different “epidemiological eras” in modern public health, each driven by a dominant paradigm concerning the causes of disease and supported by a particular analytical approach (Susser & Susser, 1996 ). This differentiation offers a useful framework within which to consider changing perspectives on the role of environment in health since the early 1900s.

The Environment in an “Era of Sanitary Statistics”

The Industrial Revolution came first to 19th-century Britain driven by technological innovation, abundant coal supplies, and supportive political/economic conditions. Also influential was a post-Reformation philosophy that extolled the work ethic and self-sufficiency. The events were to resonate throughout the world, bringing great prosperity to some, but others, especially the urban poor, endured poor housing, severe overcrowding, and an absence of wholesome water or sanitation. The growing industrial cities became crucibles of squalor, disease, and severely reduced life expectancy as their citizens suffered the ravages of typhus, tuberculosis, and successive cholera epidemics. Unhealthy working conditions and grossly polluted air also damaged health and compounded the misery of urban life at this time. Such challenges were common to all locations touched by the Industrial Revolution and became the catalyst for a new public health movement across Europe and North America (Rayner & Lang, 2012 ; Rosen, 1993 ).

Using the new science of medical statistics, investigators quickly established the locations with the poorest living conditions to be also those where disease and early death were most prevalent (Chadwick, 1842 ), fueling an ultimately transformational societal response—a “sanitary revolution” (Rosen, 1993 ). Such was the impact of this mix of slum clearance with the introduction of waterborne sewerage and piped water supplies that readers of the British Medical Journal , voting almost two centuries later, still chose it, from a shortlist of 15, as the most important medical milestone since the Journal was first published in 1840 . The 11,300 readers who voted even placed it above the discovery of antibiotics and the development of anaesthesia (Ferriman, 2007 ).

Despite its impact, the “sanitary revolution” was famously initiated and sustained on a biologically flawed paradigm regarding the mechanistic causes of disease. Yet “miasma” (the transmission of disease through noxious vapors), because it served as a metaphor for squalid insanitary conditions, still drove effective intervention (Morris et al., 2006 ; Nash, 2006 ). During this time, however, the emergence of epidemiology as the primary mode of inquiry of public health was also pivotal to success. Endorsing this view, Susser and Susser labeled the first half of the 19th century an “Era of Sanitary Statistics,” citing the frequent use of district-level data to link disease to, for example: filthy and degraded urban environments; overcrowding and poor housing and working conditions; and social factors like infant care (Susser & Susser, 1996 )).

Thus, recognition that the environment (physical and social) mattered for health and notions of a “permeable” human body in close connection with other organisms and the abiotic environment were embedded at the launch of the 19th-century public health movement. It is notable that the perspective of the reformers was quite properly “proximal,” that is, rooted in an acceptance of the importance of the local environment, physical and social. While the term “ecology” would not be coined until 1866 (Haekel, 1866 ) and “social ecology” much later still (Bookchin, 1990 ), the public health pioneers embraced what, in today’s terms, we would understand as a broadly socioecological perspective and discerned no conflict in this with their efforts to understand the immediate causes of disease and intervene in a focused way to prevent it (Nash, 2006 ).

Especially through the efforts to stop cholera, the sanitarians affirmed the pathogenic potential of unsanitary conditions and pioneered the epidemiological approach, initially as “environmental epidemiology” (Baker & Nieuwenhuijsen, 2008 ). Other legacies of the Era of Sanitary Statistics have been less enduring. Despite recent advocacy of a “precautionary principle” (see, e.g., Martuzzi, 2007 ; European Environment Agency, 2013 ), the willingness to act on the basis of strong suspicion of a societal-level environmental threat to population health has diminished, perhaps an inevitable casualty of increasing sophistication and “evidence-based” approaches in medicine and policy (Kessel, 2006 ; Brownson et al., 2009 ). Many of public health’s greatest triumphs have flowed from interventions that would have struggled to satisfy today’s evidential criteria. Also, despite a recent reconnection with such arguments, the inherent logic of seeing and tackling disease in its social and environmental context, so obvious to the pioneers of public health, has periodically been less visible in the rhetoric and actions of their successors.

It is appropriate at this point to emphasize the international character of the 19th-century public health movement. This movement can all too easily be presented as a British phenomenon, with seminal contributions from John Snow ( 1813–1858 ) on the investigation of cholera (Vinten-Johansen et al., 2003 ); William Farr ( 1807–1883 ), also on cholera but more widely on medical statistics (Susser & Adelstein,, 1975 ); Edward Jenner ( 1749–1823 ) on vaccination (Baxby, 2004 ), and Edwin Chadwick ( 1800–1890 ) on the assembly of data relating disease to the filth and squalor that came with poverty (Chadwick, 1842 ). In reality, public health, then as now, advanced through the contribution of many individuals in many nations. For example, the German pioneer of cellular biology, Rudolf Virchow ( 1821–1902 ), and his fellow countryman, the hygienist Johan Peter Frank ( 1745–1821 ), were hugely important (Rather, 1985 ). In France, Louis-Rene Vilerme ( 1782–1863 ), the doctor and pioneer of social epidemiology, highlighted links between poverty and death rates (Rosen, 1993 ) and, in the United States, the meticulous work of Lemuel Shattuck ( 1793–1859 ) bears direct comparison with that of Chadwick (Rayner & Lang, 2012 ).

It might be supposed that the consolidated outputs of European laboratories, especially in the decades between 1830 and 1870 , would have quickly expunged the miasmic paradigm from 19th-century medicine and public health. Yet, the concept of miasma was so inculcated in Western thought that, for many, it retained significant explanatory power. Thus, for much of the 19th century there was not a single settled view on disease contagion (e.g., see Kokayeff, 2013 ). Indeed, as late as 1869 some distinguished Medical Officers of Health in England still attributed diseases such as typhoid to “the insidious miasma of sewer gases” and dismissed germs as “pure nonsense.”

The Environment in an “Era of Infectious Disease Epidemiology”

Increasingly contested, the miasmic theory of disease was effectively supplanted in the 1880s by broad acceptance of the germ theory, ushering a new “Era of Infectious Disease Epidemiology” (Susser & Susser, 1996 ). In 1882 , Louis Pasteur’s techniques for growing organisms made it possible for Robert Koch ( 1843–1910 ) to demonstrate that a mycobacterium was the cause of tuberculosis and, shortly thereafter, to provide scientific proof that cholera was waterborne (Foster, 1970 ; Collard, 1976 ; Brock, 1999 ). In so doing, Koch established, what had been hypothesized by his teacher, Jacob Henle ( 1809–1885 ), some 40 years earlier that disease was microbial. Henle, Snow, Koch, and the biologist Ferdinand Cohn ( 1828–1898 ) are rightly seen as fathers of the science of medical microbiology that for a time would come to dominate thinking in medicine and public health (Rayner & Lang, 2012 ).

Initially at least, the germ theory did little to diminish interest in the environment as a determinant of health. Indeed, by revealing causal linkages between organisms isolated from their environmental carriers and specific diseases, it conferred scientific coherence on the established sanitary model and vindicated efforts to secure hygienic water, food, and housing. As Lesley Nash has observed, the germ theorists were initially content to meld the insights of bacteriology with longstanding environmental beliefs. Notions of a body in constant interaction with, and closely dependent on, its local social and physical context (in today’s terms a socioecological perspective) did not conflict with the narrower perspectives of laboratory science (Nash, 2006 ).

While relative contributions may be debated, over a short timeframe medical microbiology, isolation, immunization, and improving social/environmental conditions combined to sharply reduce the burden of infectious disease for Western society. Yet, by the early years of the 20th century , the capacity to examine disease at the microscopic level, which was the engine of diagnostics and therapeutics, was beginning to act on the very foundations that support public health. Medical science gradually made its focus the pathogenic agents of disease, moving attention away from the environment and eroding socioecological perspectives. Doctors seemed quite content to express health as an absence of disease, and medical science to project its role as the maintenance and reinforcement of “self-contained” human bodies (Nash, 2006 ). Through a growing tendency to see health, disease, and their determinants as attributes of individuals rather than characteristics of communities, wider society seemed almost complicit in an ‘individualization’ of health status. One implication of this blunting of a social/environmental thrust of public health was to divorce health from place, a development that would have profound implications in the very different epidemiological context that emerged following World War II.

The Environment in an Era of Chronic Disease Epidemiology

The dramatic reduction in infectious disease was certainly one reason why the epidemiological climate in Western society changed substantially in the mid- 20th century . But just as important was the emergence of a quite disparate set of pathologies believed to be of noncommunicable etiology. Coronary heart disease, cancers, and peptic ulcers, which became the targets in a new “Era of Chronic Disease Epidemiology” (Susser & Susser, 1996 ), were thought rather unlikely to have origins in exposure to what was an increasingly regulated and ostensibly improving physical environment. While the outputs of much postwar epidemiology seemed to endorse this view, it is useful, with hindsight, to recognize the influence of what might be seen as “fashions” in epidemiological inquiry. These fashions would influence how medical science and the wider society would come to regard diseases and their causes for a generation.

The response of the public health community to the new and alarming “noncommunicable” threats was, logically, to deploy descriptive epidemiology to reveal those most likely to be affected. Perhaps surprisingly, those who traditionally were most vulnerable to disease (the young, the old, the immunocompromised, etc.) did not appear to be at increased risk. Rather, the new epidemics disproportionately affected men in their middle years (Nabel & Braunwald, 2012 ). Supported by enhanced computing power and methodological advance (Susser & Susser, 1996 ), researchers began to converge on specific risk factors that correlated with diseases of greatest concern. Many, it seemed, were aspects of individual lifestyle and behaviors, ostensibly freely chosen. A particular attraction for the proponents of what was to become known as “risk factor epidemiology” was its capacity to represent, mathematically, the “relative risk” of contracting a disease between people exposed to a putative risk and those who were not. Some have dubbed this epidemiological approach to noncommunicable or chronic disease “black box epidemiology” because it can relate exposure to outcomes “without any necessary obligation to interpolate either intervening factors or even pathogenesis” (Susser & Susser, 1996 ). Another unfortunate characteristic of this approach to epidemiology is that, despite its laudable intent to understand and address disease in populations , its focus is on individuals within those populations. As a result, it fails to elucidate the societal forces whose influence and interplay shape the health and health-relevant choices of those individuals. When viewed through a policy lens, this mitigates in favor of simplistic solutions that target individuals divorced from context and that lack the traction to produce meaningful change.

In summary, the desire to create a mathematical measure of relative risk for a specific factor is understandable. However, risk factor epidemiology uses an approach that is much more flexible than material reality. In the real world, many different factors coexist and interact to create and destroy health. This is not, however, to deny risk factor epidemiology’s capacity, particularly in synergy with laboratory-based research, to break new ground. Notably, these methodologically driven approaches were key to elucidating links between smoking and lung cancer, heart disease and serum cholesterol, and between levels of prenatal folic acid intake and neural tube defects (Susser & Susser, 1996 ; Kessel, 2006 ; Perry, 1997 ).

The same basic criticism is voiced where similar “black box” epidemiological approaches are used to explore the contribution of a specific environmental agent, as in the case of much recent air pollution epidemiology (see below) (Kessel, 2006 ). Any specific pollutant under epidemiological investigation inevitably coexists with other pollutants and in a specific exposure context (e.g., prevailing climatic conditions). These coexisting factors may be critical in determining the health outcomes from exposure to the pollutant under investigation. Because the outputs of black box epidemiology are abstractions, the relative risk calculation represents an abstraction that can be limited in its capacity to inform policy.

The decades following World War II were a time of declining influence for public health and population perspectives, largely for reasons we have outlined. Yet, in its rhetoric and activities, the discipline of public health seemed at times almost complicit. Even its defining science of epidemiology seemed for a time more concerned to reinforce the insights of clinical medicine than to play the exploratory role on which its reputation had been founded (Susser & Susser, 1996 ). On the face of it, academic public health and the wider public health discipline had little to say about environment, no longer presenting it as an active component in the then current health challenges for Western society. As Nash has observed, physical environments were “recast as homogenous spaces which were traversed by pathogenic agents.” Nevertheless, divorced from the prevailing rhetoric, in many locations there was a parallel narrative depicting a workforce that continued to work at a local level, within established legal and administrative frameworks, to protect and maintain health-relevant environmental quality standards. However, the environmental health function was often set in the narrow, hazard-focused, and compartmentalized terms framed for it by laboratory science. The task was largely confined to identifying, monitoring, and controlling a limited set of toxic or infectious threats in their environmental carriers. Only when pathogenic organisms or toxic agents demonstrably escaped their industrial, agricultural, or marine confines to damage health and reinforce the porosity of the human body did environment briefly assume a higher profile.

Against this backdrop, it was not necessarily predictable or inevitable that environment would regain a central place in public health. Yet, by the end of the 20th century , a much richer understanding of the environmental contribution to human health and well-being had indeed emerged. This change cannot be attributed to a single factor in isolation. Some point to the key influence of Rachel Carson’s Silent Spring in 1962 (Carson, 1962 ), which expressed grave concern for the ecosystem effects of DDT, the linkage to potential human health effects, and the implications of a growing disconnect between humankind and nature. We do not deny the status of Carson’s work as a seminal text of a modern “environmentalism” that would rapidly gather pace and influence (Nash, 2006 ). However, we submit that it is only now, in the 21st century , when the reality of unprecedented anthropogenic damage to global processes and systems and its health implications is self-evident, that the health sector has fully made common cause with the environmentalist movement (e.g., see Butler et al., 2005 ; Butler & Harley, 2010 ) (We discuss this development later in this article under Ecological Public Health.

However, for reasons that are distinct from a mounting concern over anthropogenic threats to global environmental systems and processes, we argue that the closing decades of the 20th century and the early years of this century did see a rekindling of public health and societal interest in the local or proximal environment. This interest has continued into the 21st century . Developing interest in well-being as a concept, the belief that it is important and that it might be enhanced through the organized efforts of society, continues to engage the attention of academics and policymakers. Although well-being demonstrably impacts health and vice versa, well-being is about much more than health. Rather, it is a measure of what matters to people in every sphere of their lives. Despite its importance, well-being has proved a challenging target for policy. Some of its components are beyond the reach of policy. However, others, including aspects of the built and natural environment and people’s connection to it, are amenable to manipulation. Accordingly, research has been especially concerned to identify the qualities of their environment that are important for different people’s well-being, quality of life, and health at various life stages (Royal College of Physicians, 2016 ). Also, on a practical level, integrating the various well-being frameworks and indices that continue to emerge is an ongoing challenge. However, it is sufficient at this point simply to recognize that elevated concern for well-being and its connection to environment can only broaden and deepen concern for the environment in public health. It will continue to drive renewed interest in matters such as landscape, natural beauty and scenery; crime free, clean places; green, blue, and natural environments; and so on.

Reconnecting Health with Place

Five issues/developments merit particular mention for their role in reestablishing the local environment as a mainstream consideration in health in the developed world in the late 20th century . While recognizing that there is an interrelationship among some of the factors discussed, for simplicity, we discuss them separately here.

Air Pollution

In citing air pollution as a key factor in a late- 20th-century resurgence of interest in the environment, we recognize its much longer history as a contributor to ill health (Evelyn, 1661 ; Lloyd, 1983 ). We acknowledge, too, that accounts of the modern public health era since its inception have been suffused with references to air pollution events, their health implications, and the political and professional campaigns that have sought to mitigate risk (Kessel, 2006 ). However, despite a compelling case for action, the need for urgent intervention was only fully accepted after a number of high-profile air pollution episodes in the 20th century . In 1930 , a severe smog incident in Belgium’s Meuse Valley resulted in the death of sixty people. Prophetically, investigators were quick to highlight the potential for many more deaths, were such an incident to be repeated in a more highly populated area (Bell & Samet, 2005 ). In 1948 , a further twenty people were to die and many more suffer injury after an industrial pollution incident in Donora, Pennsylvania (Hamil, 2008 ), but the tipping point came four years later, with the London Smog of 1952 .

Between December 5 and December 9, a dense fog descended on London where it mixed with air, polluted by domestic and industrial emissions. The resulting thick smog was familiar to many urban dwellers, but in this case, a combination of cold weather and stagnant atmospheric conditions caused sulfur dioxide and smoke concentrations to reach and maintain extremely high levels for a sustained period. The smog had a paralyzing effect on the city’s transport system, and many other aspects of daily life were severely disrupted. But the most dramatic effects were on health. Death rates were to reach three times the normal level for the time of year, and demand for hospital beds far exceeded supply (Baker & Nieuwenhuijsen, 2008 ). While the smog dissipated after a few days, deaths rates remained high for several months thereafter. Subsequent analysis has revealed that, rather than the 3,000–4,000 deaths linked to the episode in at the time, a figure of 10,000–12,000 deaths is more probable (Bell et al., 2004 ).

The London smog is historically important, obviously because of the distressing toll in morbidity and mortality and because it catalyzed long-overdue legislative intervention in the UK in the form of the Clean Air Act of 1956 and the U.S. Clean Air Act 1963 . Critically, however, it reminded the public and politicians of the reality that, given the right conditions, population-level environmental exposures were still entirely capable of producing significant morbidity and mortality.

In combination with other factors, the clean air legislation that emerged in the wake of the smog reduced domestic and industrial fossil fuel emissions, and helped to secure significant reductions in background concentrations of smoke and sulfur dioxide (Royal College of Physicians, 2016 ). However, by the late 1980s, a new, more insidious, urban air pollution threat had begun to emerge. This pollution had its origins not in fixed-point emissions, but in the rapidly increasing numbers of motor vehicles and other fossil fuel-driven forms of transport in towns and cities. The pollutants of concern here, which lacked the visibility of the earlier sulfurous smogs, were fine particles, oxides of nitrogen, and ozone. So-called time-series analyses, using data on the temporal variation in environmental exposure and in health, aggregated over the same time period, were now applied to explore the issue of urban air pollution and health (e.g., see Pope et al., 1995 ; Dockery & Pope, 1996 ; Kessel, 2006 ). The studies revealed the cardiopulmonary effects of long-term exposure to much lower levels of ambient air pollution and, later, following further investigation, the absence of a threshold level for causing health effects. Recent outputs of ‘life-course’ epidemiology have also shown that air pollution affects health, not only through the exacerbation of symptoms in the elderly, but through various processes that have impacts from the womb, through childhood to adolescence, early adulthood, and on into middle and older age (Royal College of Physicians, 2016 ). Also, appreciation that air pollutants can be resident in the air for days or even weeks makes air pollution not simply a local problem, but one that demands source control at city, regional, and international levels. In the UK, for example, the equivalent of around 40,000 deaths every year can be attributed to fine particulates and NO 2 exposure from outdoor air (Royal College of Physicians, 2016 ).

Air pollution is probably the most thoroughly investigated of all environmental threats to health and well-being. Revelations about the true extent of its impact on health keep the issue in the headlines and emphasize the centrality of the physical environment within the public health project. Despite being a focus for academic interest and research fundings, the problem of urban air pollution is a very long way from resolution and is one factor that demands a fundamental reappraisal of how, as a species, we live, consume, and travel. (We discuss a wider, global dimension of the air pollution challenge later in this article.)

Everything Matters: The Environment as an Ingredient in Social Complexity

Another important and often overlooked reason for the late- 20th-century rekindling of interest in the environment and human health can be traced to developments within the wider discipline of public health. Ironically, the thinking behind what, by the 1990s, was being termed the “new public health” had its origins in much older ideas that gave prominence to the social structures in which health is created and destroyed (Baum, 1998 ; Awefeso, 2004 ). If we accept that health, disease, and social patterning in these matters are products of a complex interaction of influences at the level of society with the characteristics of individuals, then such complexity ought to be reflected in the policies and partnerships formed to address them. A growing number of analyses, beginning in the 1970s, would turn a spotlight on this complexity and fundamentally challenge the dominance of the biomedical/health care model and its capacity to solve the problems that beset public. These problems included the intractable burden of noncommunicable disease; growing levels of obesity; diminished psychological well-being; and, not least, stubborn and widening inequalities in the health and well-being of different social groups. Concern also mounted over containing rising, and potentially bankrupting, health care costs.

“A New Perspective on the Health of Canadians,” more commonly referred to as the Lalonde Report, after Canada’s then health minister Marc Lalonde, was published in 1974 (Lalonde, 1974 ). Despite its national focus, the report assumed wider relevance because of its analysis of one of public health’s greatest generic challenges, that of navigating among the many complex and interacting determinants of health to identify effective policies and actions. Implicitly offering a socioecological perspective, the Lalonde Report spoke of a “Health Field,” which included all matters that affect health and comprised four core elements: human biology, environment, lifestyle, and health care organization. Any issue, it was proposed, could be traced to one, or a combination, of these elements, allowing the creation of a “map of the health territory” for any problem (Lalonde, 1974 ). In this way, the contribution and interaction of the elements could be assessed. The analysis affirmed the health relevance of a complex environment comprising interacting physical and social dimensions in interaction with the human body. Lalonde’s message was logical and important, yet more than just an echo of an earlier, more inclusive, understanding of the determinants of health and disease. It recast these largely abandoned perspectives for a more scientific and sophisticated era. The proposal that thousands of “pieces” relevant to health and its determinants could be organized in “an orderly pattern” was alluring and progressive, as was the notion that the exercise alone would allow all contributors to more fully appreciate their roles and influence (Morris et al., 2006 ). In the ensuing years, Lalonde’s proposals for understanding and addressing complexity in the determinants of health have been refined and given greater policy relevance by others. In part, this has been through the development of conceptual models of the socioecological determinants of health. These models have been promoted as tools for presenting evidence that can make their implications more apparent (Evans & Stoddart, 1990 ; Dahlgren & Whitehead, 1991 ). In most of these representations, the local environment is accepted as a key driver of health and well-being (Morris et al., 2006 ).

Despite its inherent logic, the socioecological perspectives that emerged in the closing decades of the 20th century created scientific and policy challenges for all constituencies concerned with public health. There were obvious generic challenges, for example, around which of the models (each, necessarily, a gross simplification of a complex reality) might point to solutions (Morris et al., 2006 ; Evans & Stoddart, 1990 ; Reis et al., 2015 ); around the nature of evidence and its interpretation (Petticrew et al., 2004 ; Tannahill, 2008 ); and how, in practice, to traverse professional and policy silos to produce the interdisciplinary approaches that are inevitably required. In this connection, the task of motivating, supporting, and delivering effective intersectoral working, an abiding challenge for public health policy and practice, assumed a much higher profile in the late 20th century with the emergence of the socioecological model of health.

We emphasize that the continuing failure to adequately confront this challenge has the gravest implications for global public health. As Prüss-Üstün et al. recently observed, “Tackling environmental risks requires intersectoral collaboration. After nearly 50 years of actively promoting this concept, whether referred to as intersectoral action, breaking down silos or the nexus approach, it remains elusive as ever. The statement ‘intersectoral collaboration: loved by all, funded by no-one’ points to obstacles, mainly vested interests, that have burdened this approach ever since it was included as part of the WHO/UNICEF Alma Ata Declaration on Primary Health Care in 1978 . Environmental health, quintessentially intersectoral, has suffered most from this lack of progress” (Prüss-Üstün et al., 2016a ).

With specific reference to the role of the local environment, the recognition of socioecological complexity as the determinant of health meant that strict adherence to narrow hazard-focused and compartmentalized approaches became intellectually unsustainable. Yet, acceptance of the dynamic interaction of environment with other determinants of health demands a richer understanding of the environmental contribution than can be provided by toxicology or microbiology in isolation.

The Role of the Environment in Health Inequalities

The fact that the poorest, most degraded urban neighborhoods were those most blighted by disease and reduced life expectancy was clear even to the public health pioneers of the 19th century . Indeed, throughout much of the modern public health era, an acceptance of the importance of the environment for health and well-being has been accompanied by a recognition of the interplay between sociodemographic, economic, and physical factors in creating and sustaining health inequalities.

The term “health inequalities” refers to general differences in health, however caused. Where the differences in health are unfair, unjust, and avoidable, as they often are when linked to social variables, they should more properly be termed “health inequities.” However, in the extensive literature on the topic and in common usage, inequities are termed inequalities, and we adopt this convention here. Despite their importance, the emphasis on tackling health inequalities has varied considerably over time and according to place.

In 2008 , the final report of the Commission on the Social Determinants of Health (CSDH, 2008 ) elevated the global profile of health inequalities and emphasized the interplay of many societal-level factors in their creation in the 21st century . The significant achievements in public health across the world over nearly two centuries have not been shared equally between countries or by all social groups within countries. An important component has been the health-relevant differences in the physical context for people’s lives—the quality of the physical environment. Sometimes expressed in terms of environmental justice , or elsewhere as environmental health inequalities, attention to this area is key to tackling health inequalities across the world (CSDH, 2008 ; Morris & Braubach, 2012 ).

Estimates of the impact of environmental quality on health and well-being vary widely, depending on the definition of environment used. However, that impact is undeniable. Over a billion people in developing countries, for example, have inadequate access to water, and 2.6 billion lack basic sanitation . The World Health Organization estimates that environmental factors were responsible for 12.6 million deaths worldwide in 2012 , 23 percent of all deaths, and 22 percent of the total burden of disease. Addressing environmental risks could prevent 26 percent of all deaths of children under the age of 5 (Prüss-Üstün et al., 2016b ).

In addition, there is clear evidence that a “good” environment empowers health through access to environmental assets such as green spaces, access to a healthy diet, and safe environments in which to walk, cycle, play, and socialize. However, as these data suggest, there is also a fundamental equity dimension to the distribution of both the cause and distribution of environmental stressors, the susceptibility to exposure, and the adverse effects of those exposures. Deprived communities almost invariably live in poorer quality environments, with higher levels of indoor and outdoor air pollution, contaminated land, polluting industrial processes, overcrowded and poor quality housing, and lower levels of environmental assets (Prüss-Üstün et al., 2016a ; 2016b ; Royal College of Physicians, 2016 ; The Marmot Review Team, 2010 ). Populations in developed countries, including the former communist states of eastern Europe living in areas of high air pollution, are disproportionately deprived, for example (Kriger et al, 2014 ; Bell & Ebisu, 2012 ; Branis & Linhartova, 2012 ; Goodman et al., 2011 ). Poor indoor air quality is associated with unfit or inadequate housing standards, conditions that overwhelmingly affect the deprived (The Marmot Review Team, 2010 ). There is evidence that deprived communities are not only more exposed to environmental hazards but are also more susceptible to the effects of those exposures (Goodman et al., 2011 ; Carder et al., 2008 ; Richardson et al., 2011 ; 2013 ; Vinikoor-Imler et al., 2012 ). There are also concerns that stress, at both the individual and community level, can weaken the body’s defenses against external insult and influence the internal dose of toxicants (Gee & Payne-Sturges, 2004 ).

This effect is also seen in social and physical environments. An adequate and nutritious diet is essential to a healthy, productive, and fulfilling life, and it is a fundamental right predicated by a range of factors including personal knowledge, choice, convenience, availability, quality, cost, and social norms. The evidence is clear that deprivation compounds all these factors, with poorer people buying more unhealthy foods with fewer healthy components while being exposed to circumstances that make such “choices” inevitable (Rudge et al., 2013 ). The proportion of adults considered overweight or obese in 2008 in the 19 EU member states for which data were available ranged between 37 and 57 percent for women and between 51 and 69 percent for men ( EUROSTAT ). English children from deprived areas are almost twice as likely to be obese than those in affluent areas, and adult obesity is also associated with deprivation, particularly in women (Public Health England, 2016 ; National Obesity Observatory, 2013 ).

The poor in developed countries are adept at sourcing cheap calories and are exposed to a large numbers of local outlets selling cheap, calorie-dense takeaway food (Saunders et al., 2015 ). These meals are often super-sized and contain high levels of fats, sugar, and salt. At the same time, many of these areas provide limited access to healthy food options, creating a highly compromised public health environment (Saunders et al., 2015 ).

In addition, environmental stressors seem to have a cumulative impact, exacerbating this inequality. It is evident that poorer people have multiple health, social, and environmental stressors. It is entirely plausible that these stressors modify the effect of exposure to pollutants, as is reflected in the increased vulnerability of obese people to the effects of exposure to air pollutants, including increased risk of diseases such as cardiovascular events and respiratory symptoms (WHO, 2013 ; Jung et al., 2014 ). Long-term exposure to airborne pollutants has also been reported to increase the risk of obesity, and being overweight or obese is associated with an increased susceptibility to indoor air pollution in urban children with asthma (Lu et al., 2013 ).

The responsibility for, and relative benefits and costs of, environmental contamination are also important components of inequality. Environmental contamination may be tolerated by communities living in the vicinity of dirty industrial processes if they perceive a benefit in terms of local employment, although that trade-off has largely broken down in developed countries as those industries have declined in the 20th and 21st centuries. On a wider scale, the environmental consequences of contemporary affluent nations’ fuel economies are borne by those populations least able to bear them and with little or no responsibility for their causation (Patz et al., 2005 ). UNICEF has projected that 75–250 million Africans will be exposed to increased water stress due to climate change by 2020 (UNICEF, 2008 ), a phenomenon overwhelmingly caused by the First World. This is a gross injustice. These are also the same people with limited powers to prevent the dumping of rich countries’ waste in their communities. One appalling example is that of the “disposal” of 500 tons of toxic waste in and around Abidjan, the capital of Cote D’Ivoire, in 2006 . This poisonous cocktail of waste oil and contaminants was the result of the trading in, and processing of, hydrocarbon fuels by multinational commodity and shipping companies, criminal levels of cost cutting, and local political corruption, which led to 17 deaths and over 30,000 injuries in one of the poorest communities in the world (Bohand et al., 2007 ) There are many other examples, including the export, often illegally, of hundreds of thousands of tons of e-waste from Western countries to Africa, China, and Asia for recycling or disposal—transferring the costs and dangerous consequences of exposure to workers, including children, and local communities in these countries that do not have the technical or regulatory systems to deal safely with these toxic materials (ILO, 2012 ). Inuit mothers in northern Canada have elevated levels of chemicals such as PCBs—generated many hundreds, if not thousands, of miles away—in their breast milk (Johansen, 2002 ).

The redistribution of the environmental injustices historically endured by the poor also perversely appears to be affecting more affluent communities in the West. The huge expansion of “fracking” in North America, for example, may be leading to an export of risks from traditional “national sacrifice zones” to areas with no previous experience of such industry, creating “profound social, cultural, and economic shocks for middle class communities losing control over their environments” (Lave & Lutz, 2014 ). Despite their relative affluence, this would nonetheless be an injustice given the constraints on local democratic input and highly questionable direct economic benefits to those communities (Kinnaman, 2011 ; Lave & Lutz, 2014 ; Sovacool, 2014 ).

During a period when environmental catalysts for distress migrations are becoming more frequent (Thomas-Hope, 2011 ), there is a moral as well as a professional duty for the Environmental Health community to tackle these inequalities, which otherwise are likely to both widen and deepen.

The Health-Promoting Environment: Green, Blue, and Natural Spaces

While human communities have long valued access to natural resources such as green spaces, the industrialization of the 19th and early 20th centuries saw millions of people deprived of this access. This era did witness some far-sighted philanthropic gifting of areas of open recreational space for the working classes driven by a moral rather than evidence-based imperative. Though welcome, the distribution of, and access to, such resources was limited, inconsistent, unplanned, and vulnerable to the insecurities of voluntary funding. Subsequent local municipal development of parks and other open spaces increased access, and a greater understanding of the benefits of such access blossomed during the late 20th century as research demonstrated and quantified the public health dividends. Access to good-quality green spaces not only makes the places in which we live, work, and play more attractive, but also has a demonstrable effect on improving health and well-being. Green space is linked to lower levels of several diseases and conditions, including lower rates of mortality (Villeneuve et al., 2012 ), increased longevity in older people (Faculty of Public Health, 2011 ), improved mental health (Faculty of Public Health, 2011 ), better outcomes in disease treatment, and reduced medication (Faculty of Public Health, 2011 ), and it also helps reduce health inequalities (Mitchell & Popham, 2008 ; CABE, 2010 ). Plausible mechanisms for these benefits include the provision of a venue for physical activity, promotion of social contact, and the direct impacts of green spaces on psychological and physical health. Natural spaces also promote greater community cohesion and reduce social isolation, providing a platform for community activities, social interaction, physical activity, and recreation (Public Health England, 2014 ). Research from the United States has identified powerful associations between green space and major reductions in aggressive behavior, domestic abuse, and other crime in deprived urban areas (Kuo et al., 2001a , 2001b ).

And yet, there remain great inequalities in the distribution, use, and quality of this empowering resource. People living in the most deprived areas are less likely to live in the greenest areas and therefore have less opportunity to gain the health benefits of green space compared with people living in the least deprived areas (Public Health England, 2014 ). Children living in poor areas, for example, are nine times less likely than those living in affluent areas to have access to green space and places to play (National Children’s Bureau, 2013 ). It is entirely plausible that that this contributes to the sobering reality that children from deprived communities are up to three times as likely to be obese than those children growing up in affluent areas (National Children’s Bureau, 2013 ).

Accessibility, however, is not the same as availability or utility, nor is it simply a function of proximity. It is strongly impacted by the cost of access, whether it is actually physically available, opening times, and the ease of being able to get to it, for example, walking and good public transport. Deprived communities in particular appreciate the value of such spaces, but they tend to underuse them due to concerns about the safety and quality of the spaces (CABE, 2010 ). Experience has shown that quality of the green space is just as important, if not more so, than its size. Post-World War II urban developments in many countries have included large grassy areas, and substantially derelict former industrial sites have often been entirely grassed over. The sterility and sheer size of these sites, the cost of maintenance, and the lack of facilities have often led to misuse and subsequent abandonment by both communities and local municipalities.

The provision, maintenance, and promotion of good-quality and safe , publicly available spaces is not a subsidy; it is an investment delivering economic, health, and regeneration benefits . Research on Philadelphia estimated that maintaining city parks could achieve huge annual savings in health care costs, stormwater management, air pollution mitigation, and social cohesion benefits (The Trust for Public Land, 2008 ). The improved social cohesion associated with natural spaces also has economic benefits. A 2009 Scottish study estimated a £7.36 dividend for every £1 invested in conservation volunteering projects (Greenspace Scotland, 2009 ). It is clear from the evidence that increasing the use of good-quality green space for all social groups is likely to improve health outcomes and reduce health inequalities.

The Reemergence of the Infectious Threat

Among the developments that, for Western societies, consigned environment to the periphery of medical and public health interest in the post–World War II era, we highlighted the epidemiological transition in the mid- 20th century . Indeed, for a period in the 1960s and 1970s it seemed that infectious disease in the developed world had effectively been conquered (Fauci, 2001 ). It was even tempting to suggest that the developing world might eventually follow suit. Yet, within a relatively few years, the twin threats of emerging infectious disease and antibiotic resistance would shatter the earlier confidence and reestablish infection as a live threat to individuals, communities, and populations and one that presented, increasingly, on a global scale.

The term “emerging infectious disease” (EID) denotes an infectious disease, newly recognized as occurring in humans; one that has been previously recognized but is appearing for the first time in a new population or a different geographic area; one that now affects many more people; and/or one that is displaying new attributes, for example, in terms of its resistance or virulence ( adapted from The US Government & Global Emerging Infectious Disease Preparedness and Response ). Although the return of infection was not necessarily anticipated by a confident global community, many predisposing factors were clearly present. Changes in land use, growth and movement of populations, contacts between people and animals, international trade and travel, and, often, an absence of a public health infrastructure all played a part. Where such influences coincided, as in sub-Saharan Africa or parts of Asia, hotspots were created that were conducive to the emergence of infectious disease. Several hundred new infectious diseases appeared across the globe in the period between 1940 and 2004 , with the greatest number emerging in the 1980s (Jones et al., 2008 ). The 1980s was also the decade that notoriously witnessed the late 20th century ’s most sentinel infection event, the first reported cases of Human Immunodeficiency Virus/Acquired Immune Deficiency Syndrome (HIV/AIDS). By 2014 , AIDS alone would result in approximately 78 million cases worldwide . Although HIV/AIDS engendered particular alarm, the list of late- 20th-century EIDs of medical and public health significance is extensive. Variant Creutzfeldt-Jacob disease (vCJD), H5N1 Influenza and Ebola Virus Disease, the Northern Hemisphere debut of the mosquito-borne zoonotic viral disease, and West Nile Fever in New York City in 1999 were all public health and media events. The process continues unabated in the 21st century with the arrival of Severe Acute Respiratory Syndrome (SARS), H1N1 Influenza (“swine flu”), H7N9 Influenza (“bird flu”), and, despite having surfaced some 40 years earlier, Ebola revealed its potential as a global threat with the West African Outbreak of 2014–2015 . More recently still, the distressing incidence of microcephaly in South America putatively linked to the Zika virus simply emphasizes the abiding challenge posed by infection for public health and global economics (European Centre for Disease Control, 2016 ).

Antibiotic resistance has been a developing public health horror story over, perhaps, 50 years. The therapeutic use of antimicrobials and especially antibiotics was a key factor in slashing the burden of illness from infection in Western countries in the latter half of the 20th century . Yet all classes of organisms—fungi, protozoa, viruses, and bacteria—can develop antimicrobial resistance. Through their genetic processes, bacteria have derived multiple resistance mechanisms to antibiotics used in medicine and agriculture. The threat renders humankind vulnerable to a host of infections, notably in hospital settings where treatment options for many infections are now severely limited. As a consequence, even at the dawn of the 21st century , drug resistance was already being perceived as an increasing threat to global public health, involving all major microbial pathogens and antimicrobial drugs (Levy & Marshall, 2004 )

The challenges of EIDs and antimicrobial resistance are, unquestionably, game changers for medicine and public health in the 21st century . Importantly, they are among the factors that have revealed the true limitations of the biomedical model of health and disease in the 20th century and rekindled interest in the socioeconomic and environmental determinants of disease. HIV/AIDS merits special mention in this regard. Although it is believed to have origins in nonhuman primates in West Africa, it is not an environmental disease in the sense that there is a specific environmental reservoir. Medical sciences and epidemiology have shown transmission of the virus via unprotected sex, contaminated blood transfusions, hypodermic needles, and mother to child transmission during pregnancy, delivery, and breastfeeding. HIV (the infection) and AIDS (the disease) have shown the capacity to extend beyond the initially identified high-risk groups, potentially placing whole populations at risk. In some areas of sub-Saharan Africa where the infection is widespread, it impacts negatively on almost every aspect of society and the economy.

Over 30 years after it first emerged and despite concerted efforts, there is still no cure. In addition to banishing complacency, the infection and the disease call for a much wider perspective than that which took root in the postwar era of scientific positivism and medical paternalism. The failure to manage the threat stems in part from an incapacity to understand where to intervene to change behaviors and to see the disease in its social and environmental context.

Ecological Public Health

Earlier in this article, we identified five issues that helped reestablish awareness of the environment as a key component in the production of human health and well-being in the late 20th century . These issues, and our understanding of them, continue to evolve to challenge the public health community and wider society in the 21st century . In the most general terms, progress seems most likely where issues and challenges are framed with reference to a much wider range of pertinent factors by developing new approaches to evidence and its synthesis; by aligning institutional, physical, and educational infrastructures to the task; and by building governance structures in which all players are accountable and yet are encouraged to unite in common cause.

However, society must now embrace an additional and potentially more devastating threat to health and well-being. Human activity, including economic activity, is now directly and indirectly driving changes to the ecosystems and planetary processes on which we rely for health, well-being, and existence. For too long, human beings have lived, moved, consumed, and pursued health and well-being as if humankind is distinct and separate from nature rather than integral to it. The consequences of this disconnect for the natural world were graphically expressed by Rachel Carson in the 1960s and many others in the ensuing years (e.g., see Rockström et al., 2009 ; Steffen et al., 2015 ). However, developments in science and technology now reveal the true extent of the crisis, its accelerating nature, and its consequences both now and in the medium and longer term.

The term “ecological public health” is increasingly being used to encapsulate a need to build health and well-being, henceforth, on ecological principles. Rayner and Lang ( 2012 ) observe that, despite appearing difficult and complex, Ecological public health “is now the 21st century ’s unavoidable task.” Thus, the already complex challenge of navigating human social complexity to deliver health, well-being, and greater equity, which has defined public health in Western society for several decades, is made more challenging still. The relationship of the environment and human health and well-being must be understood and addressed on vastly extended temporal and spatial scales.

The notion that the planet is a finite resource on which human activity can place intolerable pressure and that the consequences of doing so are potentially catastrophic has been around for some time (e.g., see Carson, 1962 ; Meadows et al., 1972 ). A contemporary evolution of this thinking is expressed by Rockstrom and colleagues. Their sentinel paper, first published in 2009 (Rockström et al., 2009 ) and updated in 2015 (Steffen et al., 2015 ), lists the large earth system processes that are urgently in need of stewardship if humanity is to remain safe into the future. Where applicable, it proposes thresholds beyond which nonlinear, abrupt, and potentially catastrophic changes in these systems might be expected. This thinking is used as a basis for defining a “safe operating space for humanity.” The authors propose nine “planetary boundaries.” Three of these—climate change, ocean acidification, and stratospheric ozone depletion—are major planetary systems where evidence exists of large-scale thresholds in the history of the planet history of the planet. Also included are systems of a rather different sort. These are the slow variables that buffer and regulate planetary resilience. These slow variables comprise interference with the nitrogen and phosphorus cycles; land-use change; rate of biodiversity loss; and freshwater use. Two parameters, air pollution and chemical pollution, are especially difficult to quantify, meaning that thresholds cannot yet be defined. It is emphasized that, while for understandable reasons, the nine systems are often discussed independently, they are interrelated in ways meaning that changes in one system have profound implications for the others. Rockstrom and colleagues observe that in the preindustrial era, all nine parameters were within the safe operating boundaries, and yet by the 1950s, change was underway, most evidently in the nitrogen cycle. By 2009 , according to their analysis, three planetary boundaries had been transgressed: climate change; rate of biodiversity loss; and the nitrogen cycle.

An implicit challenge in limiting global ecosystem damage and its multiple implications is how to achieve recognition among the public and policymakers that the choices they make either directly or indirectly cause ecosystem damage and related environmental change (Morris et al., 2015 ). Climate change is simply the most striking example, but comparable challenges over communication exist in relation to other planetary process and systems. The fundamental rethink of society, the economy, and the environment, which is necessary if health and well-being are to be built on ecological principles, will happen only if the true implications for health and well-being of a “business as usual” approach are understood, communicated, and challenged. For any population, the environmental changes that may ultimately have profound implications may take place in countries and regions well beyond their borders or may not occur for some time, conferring a temporal and/or spatial remoteness that diminishes the sense of urgency. Appreciating the importance of these “distal” pathways of ecosystem damage to human health and well-being demands a greater understanding of ecosystem services (the benefits human beings get from the natural environment) and of why they matter. It also demands a much fuller appreciation of the global connectivity of social, economic, and ecological systems (Morris et al., 2015 ; Adger et al., 2009 ).

When initiating our discussion of the role of environment in health, we observed that the modern public health era was built on an environmental conceptualization of public health. It is now inconceivable that health, well-being, health care, and equity in any of these domains can be delivered without rediscovering an environmental conceptualization of public health for the 21st century .

For Western society, ecological public health is likely to require a rethink of society, the economy, and our stewardship of the natural environment (Rayner & Lang, 2012 ). At the very least, it will demand pursuit, through policy and action, of outcomes that recognize a ‘quadruple bottom line’ measured in health and well-being, environmental quality, equity, and sustainability. The extent to which we embrace ecological principles will be evidenced in policies that address how we live (for example, the energy efficiency of our homes), how we move (particularly our reluctance to substitute travel in fossil-fueled cars with more active forms of travel); how we consume (notably how we source and produce food) and, of course how we obtain and conserve energy.

Taking Stock

Despite being necessarily selective, this article has sought to illustrate how perspectives on the role of the environment in human health and well-being have evolved over the course of the modern public health era. Perspectives can be seen to shift owing to changes in the nature of environmental hazards and risks that are themselves products of the evolution of how societies live, move around, consume, source their energy, and so on. Our understanding of the health relevance of the built and natural environments is also shaped by advances in scientific understanding and technology and a much wider economic, social, cultural, and even political context. In structuring our account, we have adopted a loose framework based on the “epidemiological eras,” elegantly articulated by two of the 20th century ’s leading epidemiologists (Susser & Susser, 1996 ). These eras are differentiated according to the dominant paradigm of the time concerning the causes of disease, each underpinned by analytical approaches to understand and prioritize risk.

The importance accorded to the environment as a mainstream public health issue arguably reached its lowest point in the decades following World War II when the tendency to regard health and disease as characteristics of individuals, rather than communities or populations, gained prominence. This approach diverted attention from social and environmental factors, divorcing health from place. Notions that humans are self-contained and impervious to context have now been largely swept away, not least because denial of a socioecological perspective hugely undermined attempts to address the most serious contemporary health challenges. Also instrumental in challenging the notion of the self-contained body has been an environmentalist movement with a particular interest in pesticide and other chemical contamination of the biosphere. The toxic effects of chemical contamination reinforce the reality of a body that is permeable and invariably in a state of intimate exchange with its surroundings. As Nash ( 2006 ) has observed, “ the singular and self-contained body of the early 20th century came, by the end of that century to seem distressingly porous and vulnerable to the modern landscape” (p. 13). We would simply add that humans exhibit comparable porosity and vulnerability to the social and economic context in which they exist.

We recognize that our account contains only limited reference to the regulatory context that has been so central to controlling the environment for public health. We consider it appropriate to sound a warning in this regard. The processes through which environment is monitored and regulated to protect human health and well-being are sometimes taken for granted. Yet, since the 1980s, pressures have mounted in most Western nations to ‘deregulate’ markets to maximize profit. These pressures have led to environmental and public health regulation being increasingly perceived by governments and markets as “red tape” and a barrier to economic enterprise. Pressure to loosen or even abandon aspects of environmental regulation has weakened formal controls, leaving society vulnerable to corporate excess and irresponsibility, with often serious impacts on public health (Oldenkamp et al., 2016 ). This is not to argue that regulation should be static. Rather, it should adapt to changing technological, social, and economic circumstances and should be appropriately funded whether it relates to the quality of the air we breathe, the water we drink, the buildings we live, learn, and work in, or the nutritional aspects of the food we eat. Neither do we deny the potential to exploit citizen science and the power of new technology to supplement conventional regulation (e.g., enabling vulnerable individuals to avoid hazardous exposures and the opportunities for personal pollution monitoring to improve research).

Mainly anthropogenic damage to planetary resources and ecosystems demands that, wherever we are in the world, public health agencies must understand not just the proximal threats to health and well-being that have been the targets of public health intervention throughout the modern public health era. They must also understand and move to prevent, counteract, and contain more distal threats to health and well-being. The distal threats derive from changes to environments that appear remote in space or time or involve a complex interaction of social, environmental, and economic influences. These are no longer abstract considerations. The unprecedented global connectivity of economic and social systems and the growing understanding of ecosystem interdependencies demand that the implications of human activity for health and well-being be recognized, understood, and addressed on a vastly extended temporal and spatial scale.

Only by build health and well-being on ecological principles (Ecological Public Health) will society effectively address the more distal threats to health and well-being from global ecosystem damage; the socioecological complexity of the proximal environment and the interconnections between these.

Conclusions

In this necessarily brief and artificially linear account, our intention has been to reinforce the enduring importance of the environment for health and well-being. Along the way, we have identified three factors that have marginalized the environment as a component of health and disease. We suggest that they continue to represent clear and present threats, undermining public health and, in the case of the latter, an existential threat to humankind.

The Threat from Medical Reductionism

This tendency to think of disease almost exclusively in terms of pathogenic agents and organic dysfunction marginalizes any influence outside the crucible of the laboratory. This trend was most evident in the decades following World War II but remains an ever-present threat.

The Separation of Health from Place

Closely related to medical reductionism is the tendency to downplay the importance of local context for life. The idea that if local environment matters, it does not matter much and, that when it comes to health and disease, the real action is not out there in the neighborhood and among the community but “over here” in the laboratory and at the level of the individual. Such perspectives are divisive. They create artificial barriers between many academic disciplines, including some medical specialties, and those working to manage and improve the local social and environmental context within which “permeable” human beings live out their lives.

The Denial of Ecology

Science now permits humans to understand the true extent to which their activities are plundering natural resources and harming the planetary systems and processes on which they depend. The pace of change is such that health, well-being, heath care, or anything approaching equity in these things will not be sustained in the medium to longer term without radically rethinking society, the environment, and the economy. The global connectivity of social, economic, and environmental systems means, ultimately, that no one is insulated from the threat whether by distance or socioeconomic circumstance. Ecological public health, the pursuit of health and well-being on ecological principles, has been described as the 21st century ’s unavoidable task. It demands recognition of the dynamic interconnections between people and their environment. Manifestly, we depend on the environment we inhabit, and we powerfully affect it. Among the clearest impediments to delivering ecological public health and preserving a viable environment for future generations are the belief that we can manipulate and conquer the natural environment without consequence, and the irresponsible capitalist imperative that subverts regulatory standards and damages and exploits the environment for profit. Both are revealed as transparent absurdities by an ecological understanding and analysis.

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Human health and the environment

Human health and the environment are inextricably linked at local, national and global scales. Exposure to environmental issues, such as pollution, climate change, extreme heat events and poor water quality, can negatively impact human health and wellbeing. Different populations and groups differ in their vulnerability to environmental degradation, climate change and extreme heat events, often as a result of age demographics and socio-economic inequalities that affect resilience.

In this Collection, we present articles that explore emerging threats to health and wellbeing posed by the environment, health benefits the environment can provide, and policies that can help improve air, water and soil quality, limit pollution and mitigate against extreme events. We welcome submissions of complementary studies and opinion pieces that can help broaden the discussion and further our understanding of the links between human health and the environment.

This Collection supports and amplifies research related to SDG 3 - Good Health and Well-being.

Niheer Dasandi, PhD

University of Birmingham, UK

Kerstin Schepanski, PhD

Freie Universität Berlin, Germany

Fiona Tang, PhD

University of New England, Australia

• Collection content
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• About this Collection

Reviews & Opinion

Where dirty air is most dangerous

Exposure to poor air quality can damage human health and incur associated costs. The severity of these impacts is not uniform around the globe, but depends on the health and density of the populations.

• Kerstin Schepanski

Climate Change

The diurnal variation of wet bulb temperatures and exceedance of physiological thresholds relevant to human health in South Asia

Human physiological thresholds for uncompensable heat stress were exceeded for more than 300 hours in South Asia between 1995 and 2020, including in the evenings, according to an analysis of the diurnal variability of wet and dry bulb temperatures in station data.

• Jenix Justine
• Joy Merwin Monteiro

Spatio-temporal dynamics of three diseases caused by Aedes -borne arboviruses in Mexico

Dong et al. analyse Aedes -borne diseases (ABDs) presence, local climate, and socio-demographic factors of 2,469 municipalities in Mexico, and apply machine learning to predict areas most at risk of ABDs clusters. Dengue was most prevalent, and socio-demographic and climatic factors influenced ABDs occurrence in different regions of Mexico.

• Latifur Khan
• Ubydul Haque

Probabilistic projections of increased heat stress driven by climate change

Exposure to dangerous heat index levels will likely increase by 50-100% in the tropics and by a factor of 3-10 in the mid-latitudes by 2100, even if the Paris Agreement goal of limiting warming to 2°C is met, according to probabilistic projections of global warming.

• Lucas R. Vargas Zeppetello
• Adrian E. Raftery
• David S. Battisti

Malaria elimination on Hainan Island despite climate change

Tian et al. use mathematical modelling to estimate the impact of various interventions on malaria incidence on Hainan Island, also taking into account climate change. They find that although malaria transmission has been exacerbated by climate change, insecticide-treated bed nets and other interventions were effective in controlling the disease.

• Huaiyu Tian
• Christopher Dye

Deforestation and climate change are projected to increase heat stress risk in the Brazilian Amazon

Complete savannization of the Amazon Basin would enhance the effects of climate change on local heat exposure and pose a risk to human health, according to climate model projections.

• Beatriz Fátima Alves de Oliveira
• Marcus J. Bottino
• Carlos A. Nobre

Protecting Brazilian Amazon Indigenous territories reduces atmospheric particulates and avoids associated health impacts and costs

More than 15 million cases of respiratory and cardiovascular infections could be prevented, saving $2 billion USD each year in human health costs by protecting indigenous lands in the Brazilian Amazon, suggest estimates of PM2.5 health impacts between 2010 and 2019.

• Paula R. Prist
• Florencia Sangermano
• Carlos Zambrana-Torrelio

Heavy metal concentrations in rice that meet safety standards can still pose a risk to human health

National safety standard for concentrations of arsenic and cadmium in commercial rice in China are sufficiently high to pose non-negligible health risks especially for chronically exposed children, according to a regionally resolved probability and fuzzy analysis for China.

• Wenfeng Tan

Current wastewater treatment targets are insufficient to protect surface water quality

SDG 6.3 targets to half the proportion of untreated wastewater discharged to the environment by 2030 will substantially improve water quality globally, but a high-resolution surface water quality model suggests key thresholds will still not be met in regions with limited existing wastewater treatment.

• Edward R. Jones
• Marc F. P. Bierkens
• Michelle T. H. van Vliet

Severe atmospheric pollution in the Middle East is attributable to anthropogenic sources

Fine particulate aerosols sampled around the Arabian Peninsula predominantly originate from anthropogenic pollution and constitute one of the leading health risk factors in the region, according to shipborne sampling and numerical atmospheric chemistry modelling.

• Sergey Osipov
• Sourangsu Chowdhury
• Jos Lelieveld

Protecting playgrounds: local-scale reduction of airborne particulate matter concentrations through particulate deposition on roadside ‘tredges’ (green infrastructure)

• Barbara A. Maher
• Tomasz Gonet
• Thomas J. Bannan

Accumulation of trace element content in the lungs of Sao Paulo city residents and its correlation to lifetime exposure to air pollution

• Nathália Villa dos Santos
• Carolina Leticia Zilli Vieira
• Petros Koutrakis

Environmental and health impacts of atmospheric CO 2 removal by enhanced rock weathering depend on nations’ energy mix

Enhanced rock weathering is competitive with other carbon sequestration strategies in terms of land, energy and water use with its overall sustainability dependent on that of the energy system supplying it, according to a process-based life cycle assessment.

• Rafael M. Eufrasio
• Euripides P. Kantzas
• David J. Beerling

Adverse health and environmental outcomes of cycling in heavily polluted urban environments

• Ewa Adamiec
• Elżbieta Jarosz-Krzemińska
• Aleksandra Bilkiewicz-Kubarek

Related reading

Nuclear power generation phase-outs redistribute US air quality and climate-related mortality risk

How a nuclear power phase-out may affect air pollution, climate and health in the future is up for debate. Here the authors assess impacts of a nuclear phase-out in the United States on ground-level ozone and fine particulate matter (PM 2.5 ).

• Lyssa M. Freese
• Guillaume P. Chossière
• Noelle E. Selin

U.S. West Coast droughts and heat waves exacerbate pollution inequality and can evade emission control policies

Heat waves and droughts increase air pollution from power plants in California, which disproportionately damages counties with a majority of people of color. Droughts cause chronic increases in pollution damages. Heat waves are responsible for the days with the highest damages.

• Amir Zeighami
• Jordan Kern
• August A. Bruno

Effect of air pollution on the human immune system

Inhaled particulates from environmental pollutants accumulate in macrophages in lung-associated lymph nodes over years, compromising immune surveillance via direct effects on immune cell function and lymphoid architecture. These findings reveal the importance of improved air quality to preserve immune health against current and emerging pathogens.

Socio-demographic factors shaping the future global health burden from air pollution

Millions of premature deaths each year can be attributed to ambient particulate air pollution. While exposure to harmful particulates decreases in future scenarios with reduced fossil fuel combustion, across much of the globe, socio-demographic factors dominate health outcomes related to air pollution.

• Xinyuan Huang

Over half of known human pathogenic diseases can be aggravated by climate change

A systematic review shows that >58% of infectious diseases confronted by humanity, via 1,006 unique pathways, have at some point been affected by climatic hazards sensitive to GHGs. These results highlight the mounting challenge for adaption and the urgent need to reduce GHG emissions.

• Camilo Mora
• Tristan McKenzie
• Erik C. Franklin

Dietary shifts can reduce premature deaths related to particulate matter pollution in China

Population growth and dietary changes affect ammonia emissions from agriculture and the concentration of particulate matter in the atmosphere. This study quantifies the adverse health impacts associated with these processes in China using a mechanistic model of particulate matter formation and transport. It also compares them with direct health impacts of changing diets upon premature death from food-related diseases.

• Xueying Liu
• Amos P. K. Tai
• Hon-Ming Lam

Health co-benefits of climate change mitigation depend on strategic power plant retirements and pollution controls

Climate mitigation policies often provide health co-benefits. Analysis of individual power plants under future climate–energy policy scenarios shows reducing air pollution-related deaths does not automatically align with emission reduction policies and that policy design needs to consider public health.

• Guannan Geng
• Steven J. Davis

The burden of heat-related mortality attributable to recent human-induced climate change

Current and future climate change is expected to impact human health, both indirectly and directly, through increasing temperatures. Climate change has already had an impact and is responsible for 37% of warm-season heat-related deaths between 1991 and 2018, with increases in mortality observed globally.

• A. M. Vicedo-Cabrera
• N. Scovronick
• A. Gasparrini

Anthropogenic emissions and urbanization increase risk of compound hot extremes in cities

Heat extremes threaten the health of urban residents with particularly strong impacts from day–night sustained heat. Observation and simulation data across eastern China show increasing risks of compound events attributed to anthropogenic emissions and urbanization.

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2021 Theses Doctoral

Essays in Health, Development and the Environment

Aguilar Gomez, Sandra

As multiple regions in the global south urbanize and transform, their social-environmental challenges also reshape. Climate change and ecological degradation intertwine with these processes in ways that have an uneven impact on people and firms with various degrees of vulnerability. In this dissertation, I look at such issues through the lens of sustainable development, with a regional emphasis on Mexico. Standard economic analyses of environmental policy focus on either reducing pollution externalities through mitigation or reducing the harms from exposure by encouraging adaptation. In practice, these issues are both critical, particularly when looking at the health effects of local air pollutants, which can be acute, and policymakers often pair information provision with short and long-run mitigation actions. In Chapter 1, I explore whether, in the context of the Mexico City air quality alert program, information policy is more effective when paired with mitigation. I find that the policy did not improve air quality or health outcomes until the mitigation component, which limited transport emissions, was introduced. I also use sensor-level traffic data, geo-tagged accident reports, and search data as a measure of awareness of the policy to unveil the mechanisms through which considerable short-run improvements in air quality and health are achieved after issuing an alert. I find that the alert reduces car usage even before the driving restrictions enter into place, suggesting that, due to an increased awareness of pollution, people reduce their trips. Chapter 2 studies the effects of regional exposure to extreme temperatures on credit delinquency rates for firms in Mexico. Our exposure variable is defined as the number of days in a quarter that minimum and maximum temperature are below 3°C and above 36°C, respectively, which correspond to the bottom 5 percent and top 5 percent of daily minimum and maximum temperature distribution in the country. We find that extreme temperatures increase delinquency. This effect is mostly driven by extreme heat, and it is concentrated on agricultural firms, but there is also an effect on non-agriculture firms. The impact on non-agricultural firms seems to be driven by general equilibrium effects in rural areas. Chapter 3, provides the first estimation of child penalties in the Mexican labor market. Using an event study approach and an instrumental variable as a robustness check, we estimate the impact of children on employment and wages, unpaid labor, and transitions between informal and formal sectors. We are the first to show that a child’s arrival significantly affects mothers’ paid and unpaid work, and it impacts members of the extended family unevenly, reinforcing traditional gender roles. While low- and middle-income women account for most of the effect of childbirth on wages, all mothers increase time spent on unpaid work.

Geographic Areas

• Mexico--Mexico City
• Sustainable development
• Sustainable agriculture
• Air--Pollution
• Working mothers
• Wages--Working mothers

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Essay on Environment and Human Health in English for Children and Students

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Life on this planet is interconnected. Nothing is isolated and everything has an impact on everything else. With concerns about climate change looming and becoming more immediate, we need to understand how our environment and health are connected.

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Long and Short Essay on Environment and Human Health in English

Below you will find some essays on environment and human health that can help you in your examinations, assignments. Select any environment and human health essay you need from the ones given below.

Short Essay on Environment and Human Health – Essay 1 (200 words)

Introduction

Human health is defined as the state of well-being with regards to the mental, physical and social aspects of the human condition. A person cannot be called healthy merely because of the absence of disease; he or she needs to be doing well in all ways to actually qualify as healthy.

Many factors play a role in determining our health – biological, nutritional, psychological and chemical. These factors can be influenced by internal and external conditions. Externally, the biggest factor that influences our health is our environment.

Environment and Human Health

Our environment isn’t merely the air we breathe, although that is a major component; it ranges from the water we drink to the soil we grow our food in to the sounds and noises in our surroundings. Each part affects us and thereby our health. With emissions from vehicles, factories and fires, our air supply is full of toxic chemicals that present the risk of lung cancer, heart disease and asthma. The food we eat is covered in pesticides that make soil less fertile and can be carcinogenic for us. The human body needs water to survive but our water sources are full of human and industrial wastes that create serious health issues.

We need to remember that we have to live in synergy with our environment. What we put out in it will come back to us. Unless we do something now, the earth will very soon no longer be a habitable planet.

Essay on Health and Environment – Essay 2 (300 words)

Human tendency has always been to subjugate our surroundings. We take pleasure in conquering and reshaping our environment as though it is beneath us and we are supreme. However, the simple truth is that humans are as dependent upon the environment as any other animals on the planet for our continued well-being. Therefore, if we harm our environment, we harm ourselves.

Health and Environment

Our physical, mental and social well-being is dependent upon our surroundings. What we put into the ecosystem is eventually cycled back to us. The pollutants we discard into this ecosystem find their way back through the air we breathe, the food we consume and the water we drink. Since we discard these pollutants because they are harmful to us, it follows that when we inadvertently consume them afterwards, they will still have harmful effects on our health.

Problems with this have been going on for quite some time. We use pesticides on our food crops because the chemicals kill the pests that could destroy the crops. However, those pesticides remain on the food when we consume them causing health problems ranging from skin problems to cancer. The pesticides also reduce the fertility of the soil ensuring that the next crop isn’t as bountiful.

Similarly, we discard human and industrial waste into whatever water body is conveniently close. But we also use the same water bodies for drinking water. Water pollution leads to diseases such as diarrhoea, dysentery, lead poisoning, polio and arsenicosis amongst others. The air is also polluted by all the gaseous emissions our activities release. Ranging from smoke from fires to emissions from vehicles and industries, these pollutants cause respiratory disorders such as asthma and bronchitis and can even result in lung cancer.

Environmental scientists have been raising the alarm for some time, but things are very critical now. Our unchecked activities have had adverse effects on the ecosystem and some of that damage is now irreversible. If we do not step up to the plate, we will render the earth uninhabitable very soon.

Essay on Environment Affects Humans Health – Essay 3 (400 words)

As per the definition by WHO, “human health is a state of complete physical, mental and social well-being and not merely the absence of disease and infirmity”. This well-being does not happen in isolation; it is affected by internal as well as external factors. Internal factors include issues inside the human body such as immune deficiencies, hormonal imbalances and genetic or congenital disorders.

External factors generally include three types of health hazards: physical hazards such as ultraviolet and radioactive radiations, noise pollution, carbon monoxide and CFCs; chemical hazards such as industrial effluents, heavy metals, pesticides and fossil fuel combustion; and biological hazards such as parasites, bacteria and viruses.

This clearly means that our health is, to a great extent, dependent upon our environment and the environmental factors that affect human health are mostly created by humans. What we release into our eco-system eventually finds its way back to us.

How Environment Affects Human Health

Since we are completely dependent on the environment to survive, it is safe to say that any changes to the environment will impact human well-being. However, the actual relationship between these two is more complex than we believed and isn’t always easy to assess. The most obvious impacts that we have seen are from deteriorating water quality, air pollution and unsanitary conditions. Radiation poisoning too has deadly consequences for human health.

The response to these issues has been an overall attempt to clean up our ecosystem. While that has worked for some countries, mostly in the developed world, it hasn’t been applied thoroughly in the developing countries of the world. Bilateral and multilateral agreements between countries have managed to address some of the more immediate concerns such as the emission of CFCs into the atmosphere and the damage done to the ozone layer by them.

The corporate world is also trying to lessen its carbon footprint and turning to ‘green’ solutions. However, there are many concerns that have yet to be addressed and are spiralling out of control such as biodiversity; on an average, one species dies out every day. In addition, it is becoming increasingly difficult to maintain a proper supply of food so that the world doesn’t starve.

We are simply too well-woven into our surroundings to be immune to the effects of any changes in those surroundings. The problem is that because the relationship between health and environment is complex, we aren’t motivated to make major changes; we’re waiting for irrefutable evidence. By the time we do get it, it might be too late.

Essay on Healthy Environment Healthy Life – Essay 4 (500 words)

We are aware of the complex strands that bind us to our environment. We have already started noticing the difference in our health and how it is related to what we do to our environment. However, a point to consider is that if a bad environment can cause harm to human health, a good environment can actually nurture it.

Unhealthy Environment Unhealthy Life

A report jointly published by the United Nations Environment Programme, the WHO, the Montreal Protocol on substances that deplete the ozone layer, the Convention on Biological Diversity and the Stockholm, Rotterdam and Basel conventions states that in the year 2012 alone, approximately 12.6 million people lost their lives due to conditions brought on by environmental pollution. UNEP also estimates that environmental degradation is behind 25 percent of all human diseases.

Environmental Pollution Impact

While environmental pollution may have an impact on everyone, research has shown that there are certain demographics that are more vulnerable to its effects – the young, the poor, women, the migrant workers and the elderly. In addition, diseases such as Ebola, Zika and SARS are emerging every few months and spreading because of overpopulation, too much livestock and the resultant environmental impact.

In order to stop the spread of these diseases, healthy ecosystems are essential. While tackling these diseases, such ecosystems can also bring about economic development, reduction of poverty, fewer risks to human well-being and the security of knowing that resources will not run out.

Mental Health

Increasingly, studies conducted on mental health are relating good mental health with exposure to nature. These studies have linked reduction of the symptoms of anxiety and depression and lowered stress levels to the presence of green space close by. In fact, people who moved to urban areas that are greener were seen to have improved mental health.

Water Contamination Impact

This is another example of environmental pollution affecting those in the lower economic strata. In countries where the income levels are middle to low, unavailability of clean water is responsible for 58 percent of the diarrhoea cases. Contaminated water and poor hygiene and sanitation are responsible for the deaths of around 3.5 million people. They also cause the premature deaths of around 25 percent of children younger than 14 years of age.

Approach to Resolution

There are several areas of immediate concern, based on the connection between poor human health and environmental degradation. Some of them are:

• Ecosystems that have degraded and natural systems on earth that are under pressure, which are more likely to cause disasters such as disease outbreaks, scarcity of food and natural disasters.
• Insufficient sanitation, poor hygiene and unsafe water that are the causes of deadly diseases, poor mental health and even hit economic productivity badly.
• Poor nutrition combined with dropping levels of physical activity, leading to the spread of non-communicable diseases.

Directly or indirectly, a healthy environment means healthy people. This is not to say that disease and malnutrition will be eliminated entirely but the incidences of these occurrences will reduce and millions of human lives will not be lost every year.

Long Essay on Impact of the Environment on Health – Essay 5 (600 words)

Human health or human well-being is affected by two main factors – individual traits or internal factors and ecological well-being or external factors. However, most of the time, when research is conducted on the human health condition, these two factors are investigated in isolation from each other. If one truly wants to answer the question – how does the environment affect individual health – one has to look at both factors in tandem. This becomes especially important now in light of climate change warnings and governmental indifference to them.

Impact of Environment on Health

The drawback with health related environmental studies or environment related health studies being conducted, especially those in the West, have narrowed their focus to concentrate on specific allergenic, infectious or toxic agents. They aren’t focusing on broader issues that cover psychological and social impacts too.

Some researchers agree that when studying human health it is important to take into account the impact of the environment of the people being studied. That impact can be seen in the fact that health inequalities exist as per the geography. In fact, health is impacted by the social and physical environment.

Additional research has also shown that there is a direct relationship between people’s mental health and the prevalence of green spaces; the more proximity to the green space, the better the mental health.

Socio-economic Differences in Environmental Impact

That the environment and human health are intertwined cannot be denied. However, that relationship works out differently in different places. In other words, depending upon where you are in the world, the immediate health concerns and the environmental factors affecting those concerns can be varied.

Developing countries tend to focus more on issues such as infant mortality, malnutrition and infectious diseases. The immediate environmental concerns in these countries are sanitation, hygiene, mining, ore processing, oil production and water quality. However, when one looks at developed nations, health concerns revolve around issues such as cancer, lung disease and heart disease. These countries have economies built around industries and those industries do not dispose off their hazardous wastes responsibly, thereby contaminating nearby water bodies and soil.

Considering these factors, it is no wonder that emphasis is placed more on the diseases than on the causes behind those diseases. The causes vary; the diseases may not necessarily do so.

Examples of Environmental Impact on Health Globally

Unfortunately, there isn’t any part of the globe that is free of environmental damage, not even the Polar Regions. If one goes looking, one will almost always find health concerns related to those environmental issues. It doesn’t help that countries such as China and India are developing very quickly. Their pace is such that environmental concerns aren’t being able to keep up with development.

Untreated human waste, industrial effluents, agricultural runoff and just plain old dumping are playing havoc with the ecology in both countries. Then there are the eastern European countries, many of which are former Soviet Union states. Over the past decades, hazardous waste such as heavy metals and nitrates were dumped without any plan or precaution. The result is badly contaminated ground water and surface water, not to mention the lowered quality of soil.

Some action is being taken finally where in such regions are being identified and efforts have been made to remediate, reclaim and restore the soil and surface water in such places; the effort comes too late, however, for the population that has already been exposed to these contaminants.

If one really wants to know what the environmental impact on health looks like, they need to stop looking at it in terms of discrete bubbles. They must study health disorders from an individual as well as an environmental perspective.

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Essay on Health and Environment

Introduction

The common goals of the health neighbourhood are to construct a consumer-targeted included number one health care tool; enhance get admission to and decrease inequity; boom the point of interest on fitness promoting and prevention, screening, and early intervention, in addition to the development of first-rate, safety, performance, and accountability (Australia authorities 2013)

Just like Vietnam, Kenya stocks not unusual place similarities primarily based totally on the case observe presented. In Kenya, the branch of public fitness turned into created with the mandate to formulate public fitness rules and suggestions and facilitate their implementation and evaluation, it’s far one of the oldest departments withinside the federal ministry of fitness (WHO n.d)

The evaluation of strengths, weaknesses, opportunities, and threats of the modern-day agencies and shipping of EPHFS

Just like withinside the Vietnam case have a look at; in Kenya, the medical expert networks expand to the grass-roots degree. Methods to contribute to the potential and functionality of communities, to lower their vulnerability and harm to fitness, are properly advanced thru the commune fitness stations (WHO n.d).

Merely like withinside the Vietnam case examine, in Kenya, the hygiene and epidemiology community is to be had from the Ministry to the nearby degree and is supported through prevention with the aid of using the commune fitness stations (WHO n.d).

Almost like withinside the Vietnam case studies, in Kenya, there may be an ailment-reporting machine in the vicinity in any respect stages. In Kenya, the tips for the detection and control of a number of the primary communicable illnesses are to be had from better ranges withinside the device (WHO n.d).

Just like in Vietnam, disorder outbreaks and different emergencies are commonly nicely managed. This may be attributed to the Covid 19 outbreak in Kenya in 2020, wherein the virus turned nicely managed. But the mechanisms to save you emergencies are much less nicely evolved (WHO n.d).

In Vietnam, the authorities have robust coverage of fairness. Elimination of hunger, relief of poverty, and the discount of downside in faraway regions are all priorities, however, in Kenya, this fairness isn’t always to be had (WHO n.d).

Just like withinside the Vietnam case observe, in Kenya the fitness workforce, in phrases of numbers, distribution (in particular to deprived regions), high-satisfactory, degree, and breadth of education, is typically inadequate (WHO n.d).

In Kenya, records are of low pleasant, with a complex shape of records collection

There is low usage of facts generation in Kenya.

There are gaps withinside the ailment surveillance device, and the nice is variable. (WHO n.d)

Opportunities

Just like withinside the Vietnam case look at, in Kenya, the general public fitness education device is developing

The worldwide aid for the improvement of public fitness on the united states of America degree, mainly that supplied with the aid of using the WHO Regional Office for East Africa, presents a possibility to bolster the implementation of EPHFs (WHO n.d).

Just like withinside the Vietnam case observe, in Kenya, a number of the worldwide donors exert on the general public fitness device via way of means of necessities that area better precedence on a few vertical packages so that balanced implementation of EPHFs primarily based totally on Kenya’s desires is tough to achieve (WHO n.d).

The connection between Vietnam and Kenya is that each country are rising nations and there are imbalances withinside the healthcare shipping and deficiencies in fitness care provision due to loss of investment and problems in assembly global regulators on fitness recommendations and regulations (WHO n.d).

What is to be discovered from Kenya is the resilience of its fitness care workers, who amid disheartening fitness care gear and long-time period authorities negligence nonetheless prosper to make a difference.

WHO. (n.d). Essential Public Health Functions; A three-u. s . a . have a look at withinside the Western Pacific Region. https://apps.who.int/iris/bitstream/handle/10665/206990/9290610824_eng.pdf?sequence=1&isAllowed=y

Australian Government Department of Health. (2013, April). National Primary Health care strategic framework. https://www1.fitness.gov.au/internet/publications/publishing.nsf/Content/NPHC-StrategicFramework~priorities-and-goals#:~:text=Build%20a%20consumer%2Dfocused%20integrated%20primary%20health%20care%20system%3B,%2

C%20safety%2C%20performance%20and%20accountability.

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Research ethics and artificial intelligence for global health: perspectives from the global forum on bioethics in research

• James Shaw 1 , 13 ,
• Joseph Ali 2 , 3 ,
• Caesar A. Atuire 4 , 5 ,
• Phaik Yeong Cheah 6 ,
• Armando Guio Español 7 ,
• Judy Wawira Gichoya 8 ,
• Adrienne Hunt 9 ,
• Daudi Jjingo 10 ,
• Katherine Littler 9 ,
• Daniela Paolotti 11 &
• Effy Vayena 12  

BMC Medical Ethics volume  25 , Article number:  46 ( 2024 ) Cite this article

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The ethical governance of Artificial Intelligence (AI) in health care and public health continues to be an urgent issue for attention in policy, research, and practice. In this paper we report on central themes related to challenges and strategies for promoting ethics in research involving AI in global health, arising from the Global Forum on Bioethics in Research (GFBR), held in Cape Town, South Africa in November 2022.

The GFBR is an annual meeting organized by the World Health Organization and supported by the Wellcome Trust, the US National Institutes of Health, the UK Medical Research Council (MRC) and the South African MRC. The forum aims to bring together ethicists, researchers, policymakers, research ethics committee members and other actors to engage with challenges and opportunities specifically related to research ethics. In 2022 the focus of the GFBR was “Ethics of AI in Global Health Research”. The forum consisted of 6 case study presentations, 16 governance presentations, and a series of small group and large group discussions. A total of 87 participants attended the forum from 31 countries around the world, representing disciplines of bioethics, AI, health policy, health professional practice, research funding, and bioinformatics. In this paper, we highlight central insights arising from GFBR 2022.

We describe the significance of four thematic insights arising from the forum: (1) Appropriateness of building AI, (2) Transferability of AI systems, (3) Accountability for AI decision-making and outcomes, and (4) Individual consent. We then describe eight recommendations for governance leaders to enhance the ethical governance of AI in global health research, addressing issues such as AI impact assessments, environmental values, and fair partnerships.

Conclusions

The 2022 Global Forum on Bioethics in Research illustrated several innovations in ethical governance of AI for global health research, as well as several areas in need of urgent attention internationally. This summary is intended to inform international and domestic efforts to strengthen research ethics and support the evolution of governance leadership to meet the demands of AI in global health research.

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Introduction

The ethical governance of Artificial Intelligence (AI) in health care and public health continues to be an urgent issue for attention in policy, research, and practice [ 1 , 2 , 3 ]. Beyond the growing number of AI applications being implemented in health care, capabilities of AI models such as Large Language Models (LLMs) expand the potential reach and significance of AI technologies across health-related fields [ 4 , 5 ]. Discussion about effective, ethical governance of AI technologies has spanned a range of governance approaches, including government regulation, organizational decision-making, professional self-regulation, and research ethics review [ 6 , 7 , 8 ]. In this paper, we report on central themes related to challenges and strategies for promoting ethics in research involving AI in global health research, arising from the Global Forum on Bioethics in Research (GFBR), held in Cape Town, South Africa in November 2022. Although applications of AI for research, health care, and public health are diverse and advancing rapidly, the insights generated at the forum remain highly relevant from a global health perspective. After summarizing important context for work in this domain, we highlight categories of ethical issues emphasized at the forum for attention from a research ethics perspective internationally. We then outline strategies proposed for research, innovation, and governance to support more ethical AI for global health.

In this paper, we adopt the definition of AI systems provided by the Organization for Economic Cooperation and Development (OECD) as our starting point. Their definition states that an AI system is “a machine-based system that can, for a given set of human-defined objectives, make predictions, recommendations, or decisions influencing real or virtual environments. AI systems are designed to operate with varying levels of autonomy” [ 9 ]. The conceptualization of an algorithm as helping to constitute an AI system, along with hardware, other elements of software, and a particular context of use, illustrates the wide variety of ways in which AI can be applied. We have found it useful to differentiate applications of AI in research as those classified as “AI systems for discovery” and “AI systems for intervention”. An AI system for discovery is one that is intended to generate new knowledge, for example in drug discovery or public health research in which researchers are seeking potential targets for intervention, innovation, or further research. An AI system for intervention is one that directly contributes to enacting an intervention in a particular context, for example informing decision-making at the point of care or assisting with accuracy in a surgical procedure.

The mandate of the GFBR is to take a broad view of what constitutes research and its regulation in global health, with special attention to bioethics in Low- and Middle- Income Countries. AI as a group of technologies demands such a broad view. AI development for health occurs in a variety of environments, including universities and academic health sciences centers where research ethics review remains an important element of the governance of science and innovation internationally [ 10 , 11 ]. In these settings, research ethics committees (RECs; also known by different names such as Institutional Review Boards or IRBs) make decisions about the ethical appropriateness of projects proposed by researchers and other institutional members, ultimately determining whether a given project is allowed to proceed on ethical grounds [ 12 ].

However, research involving AI for health also takes place in large corporations and smaller scale start-ups, which in some jurisdictions fall outside the scope of research ethics regulation. In the domain of AI, the question of what constitutes research also becomes blurred. For example, is the development of an algorithm itself considered a part of the research process? Or only when that algorithm is tested under the formal constraints of a systematic research methodology? In this paper we take an inclusive view, in which AI development is included in the definition of research activity and within scope for our inquiry, regardless of the setting in which it takes place. This broad perspective characterizes the approach to “research ethics” we take in this paper, extending beyond the work of RECs to include the ethical analysis of the wide range of activities that constitute research as the generation of new knowledge and intervention in the world.

Ethical governance of AI in global health

The ethical governance of AI for global health has been widely discussed in recent years. The World Health Organization (WHO) released its guidelines on ethics and governance of AI for health in 2021, endorsing a set of six ethical principles and exploring the relevance of those principles through a variety of use cases. The WHO guidelines also provided an overview of AI governance, defining governance as covering “a range of steering and rule-making functions of governments and other decision-makers, including international health agencies, for the achievement of national health policy objectives conducive to universal health coverage.” (p. 81) The report usefully provided a series of recommendations related to governance of seven domains pertaining to AI for health: data, benefit sharing, the private sector, the public sector, regulation, policy observatories/model legislation, and global governance. The report acknowledges that much work is yet to be done to advance international cooperation on AI governance, especially related to prioritizing voices from Low- and Middle-Income Countries (LMICs) in global dialogue.

One important point emphasized in the WHO report that reinforces the broader literature on global governance of AI is the distribution of responsibility across a wide range of actors in the AI ecosystem. This is especially important to highlight when focused on research for global health, which is specifically about work that transcends national borders. Alami et al. (2020) discussed the unique risks raised by AI research in global health, ranging from the unavailability of data in many LMICs required to train locally relevant AI models to the capacity of health systems to absorb new AI technologies that demand the use of resources from elsewhere in the system. These observations illustrate the need to identify the unique issues posed by AI research for global health specifically, and the strategies that can be employed by all those implicated in AI governance to promote ethically responsible use of AI in global health research.

RECs and the regulation of research involving AI

RECs represent an important element of the governance of AI for global health research, and thus warrant further commentary as background to our paper. Despite the importance of RECs, foundational questions have been raised about their capabilities to accurately understand and address ethical issues raised by studies involving AI. Rahimzadeh et al. (2023) outlined how RECs in the United States are under-prepared to align with recent federal policy requiring that RECs review data sharing and management plans with attention to the unique ethical issues raised in AI research for health [ 13 ]. Similar research in South Africa identified variability in understanding of existing regulations and ethical issues associated with health-related big data sharing and management among research ethics committee members [ 14 , 15 ]. The effort to address harms accruing to groups or communities as opposed to individuals whose data are included in AI research has also been identified as a unique challenge for RECs [ 16 , 17 ]. Doerr and Meeder (2022) suggested that current regulatory frameworks for research ethics might actually prevent RECs from adequately addressing such issues, as they are deemed out of scope of REC review [ 16 ]. Furthermore, research in the United Kingdom and Canada has suggested that researchers using AI methods for health tend to distinguish between ethical issues and social impact of their research, adopting an overly narrow view of what constitutes ethical issues in their work [ 18 ].

The challenges for RECs in adequately addressing ethical issues in AI research for health care and public health exceed a straightforward survey of ethical considerations. As Ferretti et al. (2021) contend, some capabilities of RECs adequately cover certain issues in AI-based health research, such as the common occurrence of conflicts of interest where researchers who accept funds from commercial technology providers are implicitly incentivized to produce results that align with commercial interests [ 12 ]. However, some features of REC review require reform to adequately meet ethical needs. Ferretti et al. outlined weaknesses of RECs that are longstanding and those that are novel to AI-related projects, proposing a series of directions for development that are regulatory, procedural, and complementary to REC functionality. The work required on a global scale to update the REC function in response to the demands of research involving AI is substantial.

These issues take greater urgency in the context of global health [ 19 ]. Teixeira da Silva (2022) described the global practice of “ethics dumping”, where researchers from high income countries bring ethically contentious practices to RECs in low-income countries as a strategy to gain approval and move projects forward [ 20 ]. Although not yet systematically documented in AI research for health, risk of ethics dumping in AI research is high. Evidence is already emerging of practices of “health data colonialism”, in which AI researchers and developers from large organizations in high-income countries acquire data to build algorithms in LMICs to avoid stricter regulations [ 21 ]. This specific practice is part of a larger collection of practices that characterize health data colonialism, involving the broader exploitation of data and the populations they represent primarily for commercial gain [ 21 , 22 ]. As an additional complication, AI algorithms trained on data from high-income contexts are unlikely to apply in straightforward ways to LMIC settings [ 21 , 23 ]. In the context of global health, there is widespread acknowledgement about the need to not only enhance the knowledge base of REC members about AI-based methods internationally, but to acknowledge the broader shifts required to encourage their capabilities to more fully address these and other ethical issues associated with AI research for health [ 8 ].

Although RECs are an important part of the story of the ethical governance of AI for global health research, they are not the only part. The responsibilities of supra-national entities such as the World Health Organization, national governments, organizational leaders, commercial AI technology providers, health care professionals, and other groups continue to be worked out internationally. In this context of ongoing work, examining issues that demand attention and strategies to address them remains an urgent and valuable task.

The GFBR is an annual meeting organized by the World Health Organization and supported by the Wellcome Trust, the US National Institutes of Health, the UK Medical Research Council (MRC) and the South African MRC. The forum aims to bring together ethicists, researchers, policymakers, REC members and other actors to engage with challenges and opportunities specifically related to research ethics. Each year the GFBR meeting includes a series of case studies and keynotes presented in plenary format to an audience of approximately 100 people who have applied and been competitively selected to attend, along with small-group breakout discussions to advance thinking on related issues. The specific topic of the forum changes each year, with past topics including ethical issues in research with people living with mental health conditions (2021), genome editing (2019), and biobanking/data sharing (2018). The forum is intended to remain grounded in the practical challenges of engaging in research ethics, with special interest in low resource settings from a global health perspective. A post-meeting fellowship scheme is open to all LMIC participants, providing a unique opportunity to apply for funding to further explore and address the ethical challenges that are identified during the meeting.

In 2022, the focus of the GFBR was “Ethics of AI in Global Health Research”. The forum consisted of 6 case study presentations (both short and long form) reporting on specific initiatives related to research ethics and AI for health, and 16 governance presentations (both short and long form) reporting on actual approaches to governing AI in different country settings. A keynote presentation from Professor Effy Vayena addressed the topic of the broader context for AI ethics in a rapidly evolving field. A total of 87 participants attended the forum from 31 countries around the world, representing disciplines of bioethics, AI, health policy, health professional practice, research funding, and bioinformatics. The 2-day forum addressed a wide range of themes. The conference report provides a detailed overview of each of the specific topics addressed while a policy paper outlines the cross-cutting themes (both documents are available at the GFBR website: https://www.gfbr.global/past-meetings/16th-forum-cape-town-south-africa-29-30-november-2022/ ). As opposed to providing a detailed summary in this paper, we aim to briefly highlight central issues raised, solutions proposed, and the challenges facing the research ethics community in the years to come.

In this way, our primary aim in this paper is to present a synthesis of the challenges and opportunities raised at the GFBR meeting and in the planning process, followed by our reflections as a group of authors on their significance for governance leaders in the coming years. We acknowledge that the views represented at the meeting and in our results are a partial representation of the universe of views on this topic; however, the GFBR leadership invested a great deal of resources in convening a deeply diverse and thoughtful group of researchers and practitioners working on themes of bioethics related to AI for global health including those based in LMICs. We contend that it remains rare to convene such a strong group for an extended time and believe that many of the challenges and opportunities raised demand attention for more ethical futures of AI for health. Nonetheless, our results are primarily descriptive and are thus not explicitly grounded in a normative argument. We make effort in the Discussion section to contextualize our results by describing their significance and connecting them to broader efforts to reform global health research and practice.

Uniquely important ethical issues for AI in global health research

Presentations and group dialogue over the course of the forum raised several issues for consideration, and here we describe four overarching themes for the ethical governance of AI in global health research. Brief descriptions of each issue can be found in Table  1 . Reports referred to throughout the paper are available at the GFBR website provided above.

The first overarching thematic issue relates to the appropriateness of building AI technologies in response to health-related challenges in the first place. Case study presentations referred to initiatives where AI technologies were highly appropriate, such as in ear shape biometric identification to more accurately link electronic health care records to individual patients in Zambia (Alinani Simukanga). Although important ethical issues were raised with respect to privacy, trust, and community engagement in this initiative, the AI-based solution was appropriately matched to the challenge of accurately linking electronic records to specific patient identities. In contrast, forum participants raised questions about the appropriateness of an initiative using AI to improve the quality of handwashing practices in an acute care hospital in India (Niyoshi Shah), which led to gaming the algorithm. Overall, participants acknowledged the dangers of techno-solutionism, in which AI researchers and developers treat AI technologies as the most obvious solutions to problems that in actuality demand much more complex strategies to address [ 24 ]. However, forum participants agreed that RECs in different contexts have differing degrees of power to raise issues of the appropriateness of an AI-based intervention.

The second overarching thematic issue related to whether and how AI-based systems transfer from one national health context to another. One central issue raised by a number of case study presentations related to the challenges of validating an algorithm with data collected in a local environment. For example, one case study presentation described a project that would involve the collection of personally identifiable data for sensitive group identities, such as tribe, clan, or religion, in the jurisdictions involved (South Africa, Nigeria, Tanzania, Uganda and the US; Gakii Masunga). Doing so would enable the team to ensure that those groups were adequately represented in the dataset to ensure the resulting algorithm was not biased against specific community groups when deployed in that context. However, some members of these communities might desire to be represented in the dataset, whereas others might not, illustrating the need to balance autonomy and inclusivity. It was also widely recognized that collecting these data is an immense challenge, particularly when historically oppressive practices have led to a low-trust environment for international organizations and the technologies they produce. It is important to note that in some countries such as South Africa and Rwanda, it is illegal to collect information such as race and tribal identities, re-emphasizing the importance for cultural awareness and avoiding “one size fits all” solutions.

The third overarching thematic issue is related to understanding accountabilities for both the impacts of AI technologies and governance decision-making regarding their use. Where global health research involving AI leads to longer-term harms that might fall outside the usual scope of issues considered by a REC, who is to be held accountable, and how? This question was raised as one that requires much further attention, with law being mixed internationally regarding the mechanisms available to hold researchers, innovators, and their institutions accountable over the longer term. However, it was recognized in breakout group discussion that many jurisdictions are developing strong data protection regimes related specifically to international collaboration for research involving health data. For example, Kenya’s Data Protection Act requires that any internationally funded projects have a local principal investigator who will hold accountability for how data are shared and used [ 25 ]. The issue of research partnerships with commercial entities was raised by many participants in the context of accountability, pointing toward the urgent need for clear principles related to strategies for engagement with commercial technology companies in global health research.

The fourth and final overarching thematic issue raised here is that of consent. The issue of consent was framed by the widely shared recognition that models of individual, explicit consent might not produce a supportive environment for AI innovation that relies on the secondary uses of health-related datasets to build AI algorithms. Given this recognition, approaches such as community oversight of health data uses were suggested as a potential solution. However, the details of implementing such community oversight mechanisms require much further attention, particularly given the unique perspectives on health data in different country settings in global health research. Furthermore, some uses of health data do continue to require consent. One case study of South Africa, Nigeria, Kenya, Ethiopia and Uganda suggested that when health data are shared across borders, individual consent remains necessary when data is transferred from certain countries (Nezerith Cengiz). Broader clarity is necessary to support the ethical governance of health data uses for AI in global health research.

Recommendations for ethical governance of AI in global health research

Dialogue at the forum led to a range of suggestions for promoting ethical conduct of AI research for global health, related to the various roles of actors involved in the governance of AI research broadly defined. The strategies are written for actors we refer to as “governance leaders”, those people distributed throughout the AI for global health research ecosystem who are responsible for ensuring the ethical and socially responsible conduct of global health research involving AI (including researchers themselves). These include RECs, government regulators, health care leaders, health professionals, corporate social accountability officers, and others. Enacting these strategies would bolster the ethical governance of AI for global health more generally, enabling multiple actors to fulfill their roles related to governing research and development activities carried out across multiple organizations, including universities, academic health sciences centers, start-ups, and technology corporations. Specific suggestions are summarized in Table  2 .

First, forum participants suggested that governance leaders including RECs, should remain up to date on recent advances in the regulation of AI for health. Regulation of AI for health advances rapidly and takes on different forms in jurisdictions around the world. RECs play an important role in governance, but only a partial role; it was deemed important for RECs to acknowledge how they fit within a broader governance ecosystem in order to more effectively address the issues within their scope. Not only RECs but organizational leaders responsible for procurement, researchers, and commercial actors should all commit to efforts to remain up to date about the relevant approaches to regulating AI for health care and public health in jurisdictions internationally. In this way, governance can more adequately remain up to date with advances in regulation.

Second, forum participants suggested that governance leaders should focus on ethical governance of health data as a basis for ethical global health AI research. Health data are considered the foundation of AI development, being used to train AI algorithms for various uses [ 26 ]. By focusing on ethical governance of health data generation, sharing, and use, multiple actors will help to build an ethical foundation for AI development among global health researchers.

Third, forum participants believed that governance processes should incorporate AI impact assessments where appropriate. An AI impact assessment is the process of evaluating the potential effects, both positive and negative, of implementing an AI algorithm on individuals, society, and various stakeholders, generally over time frames specified in advance of implementation [ 27 ]. Although not all types of AI research in global health would warrant an AI impact assessment, this is especially relevant for those studies aiming to implement an AI system for intervention into health care or public health. Organizations such as RECs can use AI impact assessments to boost understanding of potential harms at the outset of a research project, encouraging researchers to more deeply consider potential harms in the development of their study.

Fourth, forum participants suggested that governance decisions should incorporate the use of environmental impact assessments, or at least the incorporation of environment values when assessing the potential impact of an AI system. An environmental impact assessment involves evaluating and anticipating the potential environmental effects of a proposed project to inform ethical decision-making that supports sustainability [ 28 ]. Although a relatively new consideration in research ethics conversations [ 29 ], the environmental impact of building technologies is a crucial consideration for the public health commitment to environmental sustainability. Governance leaders can use environmental impact assessments to boost understanding of potential environmental harms linked to AI research projects in global health over both the shorter and longer terms.

Fifth, forum participants suggested that governance leaders should require stronger transparency in the development of AI algorithms in global health research. Transparency was considered essential in the design and development of AI algorithms for global health to ensure ethical and accountable decision-making throughout the process. Furthermore, whether and how researchers have considered the unique contexts into which such algorithms may be deployed can be surfaced through stronger transparency, for example in describing what primary considerations were made at the outset of the project and which stakeholders were consulted along the way. Sharing information about data provenance and methods used in AI development will also enhance the trustworthiness of the AI-based research process.

Sixth, forum participants suggested that governance leaders can encourage or require community engagement at various points throughout an AI project. It was considered that engaging patients and communities is crucial in AI algorithm development to ensure that the technology aligns with community needs and values. However, participants acknowledged that this is not a straightforward process. Effective community engagement requires lengthy commitments to meeting with and hearing from diverse communities in a given setting, and demands a particular set of skills in communication and dialogue that are not possessed by all researchers. Encouraging AI researchers to begin this process early and build long-term partnerships with community members is a promising strategy to deepen community engagement in AI research for global health. One notable recommendation was that research funders have an opportunity to incentivize and enable community engagement with funds dedicated to these activities in AI research in global health.

Seventh, forum participants suggested that governance leaders can encourage researchers to build strong, fair partnerships between institutions and individuals across country settings. In a context of longstanding imbalances in geopolitical and economic power, fair partnerships in global health demand a priori commitments to share benefits related to advances in medical technologies, knowledge, and financial gains. Although enforcement of this point might be beyond the remit of RECs, commentary will encourage researchers to consider stronger, fairer partnerships in global health in the longer term.

Eighth, it became evident that it is necessary to explore new forms of regulatory experimentation given the complexity of regulating a technology of this nature. In addition, the health sector has a series of particularities that make it especially complicated to generate rules that have not been previously tested. Several participants highlighted the desire to promote spaces for experimentation such as regulatory sandboxes or innovation hubs in health. These spaces can have several benefits for addressing issues surrounding the regulation of AI in the health sector, such as: (i) increasing the capacities and knowledge of health authorities about this technology; (ii) identifying the major problems surrounding AI regulation in the health sector; (iii) establishing possibilities for exchange and learning with other authorities; (iv) promoting innovation and entrepreneurship in AI in health; and (vi) identifying the need to regulate AI in this sector and update other existing regulations.

Ninth and finally, forum participants believed that the capabilities of governance leaders need to evolve to better incorporate expertise related to AI in ways that make sense within a given jurisdiction. With respect to RECs, for example, it might not make sense for every REC to recruit a member with expertise in AI methods. Rather, it will make more sense in some jurisdictions to consult with members of the scientific community with expertise in AI when research protocols are submitted that demand such expertise. Furthermore, RECs and other approaches to research governance in jurisdictions around the world will need to evolve in order to adopt the suggestions outlined above, developing processes that apply specifically to the ethical governance of research using AI methods in global health.

Research involving the development and implementation of AI technologies continues to grow in global health, posing important challenges for ethical governance of AI in global health research around the world. In this paper we have summarized insights from the 2022 GFBR, focused specifically on issues in research ethics related to AI for global health research. We summarized four thematic challenges for governance related to AI in global health research and nine suggestions arising from presentations and dialogue at the forum. In this brief discussion section, we present an overarching observation about power imbalances that frames efforts to evolve the role of governance in global health research, and then outline two important opportunity areas as the field develops to meet the challenges of AI in global health research.

Dialogue about power is not unfamiliar in global health, especially given recent contributions exploring what it would mean to de-colonize global health research, funding, and practice [ 30 , 31 ]. Discussions of research ethics applied to AI research in global health contexts are deeply infused with power imbalances. The existing context of global health is one in which high-income countries primarily located in the “Global North” charitably invest in projects taking place primarily in the “Global South” while recouping knowledge, financial, and reputational benefits [ 32 ]. With respect to AI development in particular, recent examples of digital colonialism frame dialogue about global partnerships, raising attention to the role of large commercial entities and global financial capitalism in global health research [ 21 , 22 ]. Furthermore, the power of governance organizations such as RECs to intervene in the process of AI research in global health varies widely around the world, depending on the authorities assigned to them by domestic research governance policies. These observations frame the challenges outlined in our paper, highlighting the difficulties associated with making meaningful change in this field.

Despite these overarching challenges of the global health research context, there are clear strategies for progress in this domain. Firstly, AI innovation is rapidly evolving, which means approaches to the governance of AI for health are rapidly evolving too. Such rapid evolution presents an important opportunity for governance leaders to clarify their vision and influence over AI innovation in global health research, boosting the expertise, structure, and functionality required to meet the demands of research involving AI. Secondly, the research ethics community has strong international ties, linked to a global scholarly community that is committed to sharing insights and best practices around the world. This global community can be leveraged to coordinate efforts to produce advances in the capabilities and authorities of governance leaders to meaningfully govern AI research for global health given the challenges summarized in our paper.

Limitations

Our paper includes two specific limitations that we address explicitly here. First, it is still early in the lifetime of the development of applications of AI for use in global health, and as such, the global community has had limited opportunity to learn from experience. For example, there were many fewer case studies, which detail experiences with the actual implementation of an AI technology, submitted to GFBR 2022 for consideration than was expected. In contrast, there were many more governance reports submitted, which detail the processes and outputs of governance processes that anticipate the development and dissemination of AI technologies. This observation represents both a success and a challenge. It is a success that so many groups are engaging in anticipatory governance of AI technologies, exploring evidence of their likely impacts and governing technologies in novel and well-designed ways. It is a challenge that there is little experience to build upon of the successful implementation of AI technologies in ways that have limited harms while promoting innovation. Further experience with AI technologies in global health will contribute to revising and enhancing the challenges and recommendations we have outlined in our paper.

Second, global trends in the politics and economics of AI technologies are evolving rapidly. Although some nations are advancing detailed policy approaches to regulating AI more generally, including for uses in health care and public health, the impacts of corporate investments in AI and political responses related to governance remain to be seen. The excitement around large language models (LLMs) and large multimodal models (LMMs) has drawn deeper attention to the challenges of regulating AI in any general sense, opening dialogue about health sector-specific regulations. The direction of this global dialogue, strongly linked to high-profile corporate actors and multi-national governance institutions, will strongly influence the development of boundaries around what is possible for the ethical governance of AI for global health. We have written this paper at a point when these developments are proceeding rapidly, and as such, we acknowledge that our recommendations will need updating as the broader field evolves.

Ultimately, coordination and collaboration between many stakeholders in the research ethics ecosystem will be necessary to strengthen the ethical governance of AI in global health research. The 2022 GFBR illustrated several innovations in ethical governance of AI for global health research, as well as several areas in need of urgent attention internationally. This summary is intended to inform international and domestic efforts to strengthen research ethics and support the evolution of governance leadership to meet the demands of AI in global health research.

Data availability

All data and materials analyzed to produce this paper are available on the GFBR website: https://www.gfbr.global/past-meetings/16th-forum-cape-town-south-africa-29-30-november-2022/ .

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Acknowledgements

We would like to acknowledge the outstanding contributions of the attendees of GFBR 2022 in Cape Town, South Africa. This paper is authored by members of the GFBR 2022 Planning Committee. We would like to acknowledge additional members Tamra Lysaght, National University of Singapore, and Niresh Bhagwandin, South African Medical Research Council, for their input during the planning stages and as reviewers of the applications to attend the Forum.

This work was supported by Wellcome [222525/Z/21/Z], the US National Institutes of Health, the UK Medical Research Council (part of UK Research and Innovation), and the South African Medical Research Council through funding to the Global Forum on Bioethics in Research.

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JS led the writing, contributed to conceptualization and analysis, critically reviewed and provided feedback on drafts of this paper, and provided final approval of the paper. JA contributed to conceptualization and analysis, critically reviewed and provided feedback on drafts of this paper, and provided final approval of the paper. CA contributed to conceptualization and analysis, critically reviewed and provided feedback on drafts of this paper, and provided final approval of the paper. PYC contributed to conceptualization and analysis, critically reviewed and provided feedback on drafts of this paper, and provided final approval of the paper. AE contributed to conceptualization and analysis, critically reviewed and provided feedback on drafts of this paper, and provided final approval of the paper. JWG contributed to conceptualization and analysis, critically reviewed and provided feedback on drafts of this paper, and provided final approval of the paper. AH contributed to conceptualization and analysis, critically reviewed and provided feedback on drafts of this paper, and provided final approval of the paper. DJ contributed to conceptualization and analysis, critically reviewed and provided feedback on drafts of this paper, and provided final approval of the paper. KL contributed to conceptualization and analysis, critically reviewed and provided feedback on drafts of this paper, and provided final approval of the paper. DP contributed to conceptualization and analysis, critically reviewed and provided feedback on drafts of this paper, and provided final approval of the paper. EV contributed to conceptualization and analysis, critically reviewed and provided feedback on drafts of this paper, and provided final approval of the paper.

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Shaw, J., Ali, J., Atuire, C.A. et al. Research ethics and artificial intelligence for global health: perspectives from the global forum on bioethics in research. BMC Med Ethics 25 , 46 (2024). https://doi.org/10.1186/s12910-024-01044-w

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Air Pollution Effects on the Health and Environment Essay

According to the National Ambient Air Quality Standards, there are six principal air pollutants, the excess of which critically affects the health, lifestyle, and welfare of the population. They are carbon monoxide, lead, nitrogen dioxide, ozone, particle pollution, and sulfur dioxide. Increasing the level of each of them will most likely have critical consequences, and should be regulated by governmental services. Still, to my mind, the priority should be given to the regulation of particle pollution as the most dangerous issue.

Particle pollution or “Particulate matter,” PM, is an effect caused by contamination of air by the particles of different origin. They might be dust, small droplets of nitric and sulfuric acids, coal and metal particles, organic chemicals, etc. The particles are subdivided into two groups. The size of “inhalable coarse particles” lies within the range of 2.5 and 10 micrometers (“The United States Environmental Protection Agency: Particulate Matter” par. 3). “Fine particles” are 2.5 micrometers and smaller (“The United States Environmental Protection Agency: Particulate Matter” par. 4). The particles are majorly concentrated along the roadways and in the areas of dusty industries. Forest fires, being a significant issue recently all over the U.S., are a substantial source of PM (Langmann et al. 109). Gas emissions from cars, industries, and power plants also contribute to particle pollution.

The level of particle pollution is regulated both by primary and secondary standards, meaning that high levels of PM will affect both sensitive categories of people and the welfare such as animals, crops, and buildings. The health dangers lay within lungs and heart disease that might cause death, as well as asthma, heart attacks, respiratory symptoms, etc. In general, 500,000 deaths occur due to particle pollution annually (Nel, 804). The damage to welfare and environment can be described as contamination of water bodies with acids, affecting the nutrient balance of soils and coastal waters, destroying forests and crops. Acid rains “resulted by sulfur oxides transformation into acids, especially sulfuric acid, besides causing leaf burns, contribute to the acidity increase of naturally acid soils and to lowering the buffering capacity of base saturated top soils” (Lacatusu, Cimpeanu and Lungu 818) are also the result of particle pollution. PM can also cause discomfort and danger, conducting a reduction of visibility.

The factor that demonstrates the extreme danger and the priority of dealing with an issue of particle pollutions is that its standard was reviewed in 2012 the latest date if compare to revisions of other major pollutants (“The United States Environmental Protection Agency: National Ambient Air Quality Standards” par.3). The general recommendations to reduce particle pollution on the household level include not to burn leaves, use the energy sources thoughtfully, avoid using fireplaces and dust-producing devices. These measures are high, but some more effective means should be provided on the state level. They might be introducing the policy of power plants emission reduction by providing more environmental-friendly technologies. This also refers to encouraging using a vehicle with low rates of dangerous emissions. The practice of short-term air pollution forecasts and the regulation of the industrial and household emissions in the area, based on those forecasts (Berlyand 12), seems to be a good idea. The policy of forest fires prevention also should be improved.

Particle pollution is one of the major issues affecting the environment all over the United States. As is, it occurs due to industrial problems and natural catastrophes and might result in drastic consequences for the population’s health and welfare; the environmental policy should be reviewed to reduce the rates of pollution.

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Lacatusu, Radu, Carmen Cimpeanu, Mihaela Lungu. “Soil pollution by acid rains and heavy metals in Zlatna region, Romania.” Sustaining the Global Farm, Purdue University (2001): 817-820. Print.

Langmann, Bärbel, Bryan Duncan, Christiane Textor, Jörg Trentmann, Guido R. vander Werf. “Vegetation fire emissions and their impact on air pollution and climate.” Atmospheric Environment 43.1 (2009): 107-116. Print.

Nel, André. “Air pollution-related illness: effects of particles.” Science 308.5723 (2005): 804-806. Print.

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Bacteria and material made from corn kernels can clean up PCBs in aquatic environments

Researchers funded by NIEHS demonstrated a new method to clean up aquatic ecosystems using biochar — the carbon-rich byproduct of burning plant matter — and bacteria. Their cost-effective strategy has the potential to destroy polychlorinated biphenyls (PCBs), a group of harmful chemicals that persist in sediments.

Current strategies to remove PCBs from the environment, such as excavating sediments from the bottom of aquatic ecosystems, are costly and can result in water contamination. Remediation strategies that use bacteria to break down pollutants show promise, but bacteria are unable to fully degrade PCBs in the environment. To address this challenge, the team investigated whether adding biochar to solutions with bacteria and PCBs could enhance the performance of a type of PCB-degrading bacteria called Paraburkholderia xenovorans.

The scientists tested different types of biochar, including three natural biochars — made from burning corn kernels, bamboo, and wood — and activated carbon, which is commonly used in water treatment. Next, they measured the effects of each biochar on bacterial growth, bacterial attachment to biochar particles, and expression of bacterial genes that degrade PCBs.

Imaging analysis revealed that bacteria cells attached to the corn kernel biochar in greater numbers compared to the other types of biochar. Bacterial growth was also higher in the solution with the corn kernel material. In addition, there was increased expression of bacterial genes involved in PCB degradation in the corn kernel biochar solution compared with the other materials.

These findings suggest that combining biochar made from corn kernels and PCB-degrading bacteria may provide a cost-effective strategy to clean up contaminated sediments while protecting public and ecosystem health, according to the authors.

Citation : Dong Q, LeFevre GH, Mattes TE. 2024. Black carbon impacts on Paraburkholderia xenovorans strain LB400 cell enrichment and activity: implications toward lower-chlorinated polychlorinated biphenyls biodegradation potential . Environ Sci Technol 58(8):3895-907.

New lab model reveals the underlying mechanisms of PM2.5-induced lung disease

NIEHS-funded researchers developed a new model to study how fine particulate matter (PM2.5) exposure may lead to respiratory disease. The new multicellular model addresses the limitations of current methods, which use only one type of lung cell and are unable to capture the biological complexity of the respiratory system.

Upon breathing in PM2.5 air pollution, tiny particles enter the lung and are deposited in the alveolar capillary region (ACR), where gas exchange occurs. This exposure is linked to respiratory disease; however, the mechanisms are not well understood.

The scientists created a model using three types of lung cells and assembled them to mimic the structure of the ACR. The model included alveolar cells, which cover the surface of the ACR; fibroblasts, which support ACR connective tissue; and endothelial cells, which form the inner lining of blood vessels within the ACR. Then, they exposed the alveolar cells to a type of PM2.5 found in diesel exhaust for 24 hours and analyzed each cell’s response.

PM2.5 altered gene expression in both alveolar cells and endothelial cells. However, endothelial cells had more gene expression changes, despite having indirect contact with the particles. Endothelial cells also developed a type of biological stress, which led them to produce proteins that cause inflammation — an indicator of respiratory disease. Further analysis revealed that a cell signaling pathway in epithelial cells, known as mitogen activated protein kinase, played a key role in the changes observed in the endothelial cells.

The study shows that changes in endothelial cells may play an important role in how PM2.5 exposure leads to lung disease, according to the authors. They also noted that models that include multiple types of lung cells can help expand our understanding of how respiratory disease develops.

Citation : Vitucci ECM, Simmons AE, Martin EM, McCullough SD. 2024. Epithelial MAPK signaling directs endothelial NRF2 signaling and IL-8 secretion in a tri-culture model of the alveolar-microvascular interface following diesel exhaust particulate (DEP) exposure . Part Fibre Toxicol 21(1):15.

New strategy to prioritize PFAS for health risk assessments

An NIEHS-funded team developed a screening method that uses human-derived cells to evaluate how PFAS might affect health. The new approach might help prioritize different PFAS for further testing in efforts to improve health risk assessments.

PFAS are a large group of chemicals widely used in consumer products, but the majority lack toxicity data, making risk evaluation difficult. The most widely accepted approach to assess large numbers of PFAS organizes the chemicals based on structural similarities and then selects a few representative compounds for further testing.

In this study, the team explored a different approach using liver and heart cells grown in a lab and exposing them to 26 different PFAS. They looked at how the chemicals affected cell function and gene expression.

PFAS had minimal effect on liver cell function. In contrast, exposure to eight of the 26 compounds resulted in decreased beating frequency in heart cells. Genetic expression analysis of liver cells showed increased activity in genes that regulate stress and cellular structure, but decreased activity in genes that break down fats. In heart cells, PFAS exposure decreased the expression of genes related to how the heart contracts.

To compare their approach to the traditional structure-based grouping method, the team looked for associations between PFAS molecular weight or chemical structure and the observed biological effects. They found no structural similarities among compounds with similar biological effects.

These results suggest that grouping PFAS by structure alone might not adequately predict individual chemicals’ health effects, according to the authors. Their strategy could guide researchers and policymakers in determining which chemicals to prioritize for future evaluation.

Citation : Tsai HD, Ford LC, Chen Z, Dickey AN, Wright FA, Rusyn I. 2024. Risk-based prioritization of PFAS using phenotypic and transcriptomic data from human induced pluripotent stem cell-derived hepatocytes and cardiomyocytes . ALTEX; [Online 22 Feb 2024].

Inhibiting mitochondria-related protein may protect against neurodegenerative diseases

Partially blocking Drp1, a protein critical for mitochondrial division, may protect against neurodegenerative diseases, according to an NIEHS-funded study. Mitochondria are small cellular structures that produce energy for cells to carry out various functions.

Mitochondrial dysfunction and errors in autophagy, a cellular process that degrades and recycles old cellular components, have been linked to various neurodegenerative disorders, including parkinsonism — an umbrella term for conditions that cause movement symptoms that closely resemble Parkinson's disease. Previous studies have shown that partial reduction of Drp1 may shield against neurodegeneration, but the mechanisms behind this process are not well understood.

First, the scientists used lab-grown cells, derived from human and rat brain cells, to examine the effects of blocking Drp1. Then, they conducted studies in mice with normal Drp1 protein levels and mice that produced approximately one-half the typical amount. They gave the mice either water alone or water containing manganese, a metal implicated in mitochondrial and autophagy impairment, daily for 30 days. Finally, the team analyzed alterations in mouse brain genes and mitochondrial activity.

Results from both cell and animal studies showed that exposure to low nontoxic levels of manganese had no effect on mitochondrial function. However, low-level manganese exposure decreased autophagy rates and increased levels of alpha-synuclein, a protein linked to parkinsonism. In addition, partially blocking Drp1 significantly reduced the damaging effects of manganese on autophagy.

According to the authors, these findings indicate that Drp1 plays an important role in autophagy, independent of mitochondrial activity, and may be a useful target for interventions to treat certain neurodegenerative diseases. Furthermore, the results suggest that exposure to manganese may increase the risk of parkinsonism by increasing the accumulation of alpha-synuclein.

Citation : Fan RZ, Sportelli C, Lai Y, Salehe S, Pinnell JR, Brown HJ, Richardson JR, Luo S, Tieu K. 2024. A partial Drp1 knockout improves autophagy flux independent of mitochondrial function . Mol Neurodegener 19(1):26.

(Mali Velasco is a research and communication specialist for MDB Inc., a contractor for the NIEHS Division of Extramural Research and Training.)

Read the current Superfund Research Program Research Brief . New issues are published on the first Wednesday of every month.

Victor Mukhin

• Scientific Program

Title : Active carbons as nanoporous materials for solving of environmental problems

However, up to now, the main carriers of catalytic additives have been mineral sorbents: silica gels, alumogels. This is obviously due to the fact that they consist of pure homogeneous components SiO2 and Al2O3, respectively. It is generally known that impurities, especially the ash elements, are catalytic poisons that reduce the effectiveness of the catalyst. Therefore, carbon sorbents with 5-15% by weight of ash elements in their composition are not used in the above mentioned technologies. However, in such an important field as a gas-mask technique, carbon sorbents (active carbons) are carriers of catalytic additives, providing effective protection of a person against any types of potent poisonous substances (PPS). In ESPE “JSC "Neorganika" there has been developed the technology of unique ashless spherical carbon carrier-catalysts by the method of liquid forming of furfural copolymers with subsequent gas-vapor activation, brand PAC. Active carbons PAC have 100% qualitative characteristics of the three main properties of carbon sorbents: strength - 100%, the proportion of sorbing pores in the pore space – 100%, purity - 100% (ash content is close to zero). A particularly outstanding feature of active PAC carbons is their uniquely high mechanical compressive strength of 740 ± 40 MPa, which is 3-7 times larger than that of  such materials as granite, quartzite, electric coal, and is comparable to the value for cast iron - 400-1000 MPa. This allows the PAC to operate under severe conditions in moving and fluidized beds.  Obviously, it is time to actively develop catalysts based on PAC sorbents for oil refining, petrochemicals, gas processing and various technologies of organic synthesis.

Victor M. Mukhin was born in 1946 in the town of Orsk, Russia. In 1970 he graduated the Technological Institute in Leningrad. Victor M. Mukhin was directed to work to the scientific-industrial organization "Neorganika" (Elektrostal, Moscow region) where he is working during 47 years, at present as the head of the laboratory of carbon sorbents.     Victor M. Mukhin defended a Ph. D. thesis and a doctoral thesis at the Mendeleev University of Chemical Technology of Russia (in 1979 and 1997 accordingly). Professor of Mendeleev University of Chemical Technology of Russia. Scientific interests: production, investigation and application of active carbons, technological and ecological carbon-adsorptive processes, environmental protection, production of ecologically clean food.   

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