Damian Sendler: An epidemiological transition, from communicable to non-communicable disease, and a geological transition that is moving the planet beyond the Holocene epoch in which human societies have thrived, have been linked to industrialization and urbanization, respectively. High-income countries’ lifestyles play a major role in both processes. It is our goal to bring attention to the links between chronic disease and environmental change in order to promote a more holistic approach to environmental and public health issues.
Damian Jacob Sendler: Biophysical environments can be incorporated into SDH frameworks but are treated as determinants that are distinct from the social factors that influence them. It is more common for environmental frameworks to portray the environment and its ecosystems as the result of human activity. The combination of public health and environmental sustainability can be achieved through some frameworks that also consider human health as an outcome. Public health officials’ concern for individual risk behaviors is broadened by environmental analyses of household impacts, which point to the more harmful lifestyles of high-income households.
Dr. Sendler: Rapid environmental change is threatening the foundations of health. Frameworks that span public health and environmental sustainability are needed, as is a common evidence base that captures the harmful effects of high consumption on both health and the environment.
Increasing living standards and longer lifespans have been made possible by the simultaneous processes of industrialization and urbanization over the past century or so.
Numbers 1 and 2 Rapid alterations in people’s habits, such as increased physical activity and a shift in diet, have been linked to these improvements. This has resulted in a shift from a plant-based diet to one based on animal products, such as dairy products, meat, and processed meats, in the workplace and on the road. Three, four, five and six
As a result of these societal and economic shifts, a shift in epidemiology has taken place as well. Non-communicable disease has overtaken communicable disease as the leading cause of ill health and premature death in high-income countries and around the world since the early industrialization of North America and Europe. Then there’s nine. Physical inactivity and poor diet are the most direct determinants of heart disease risk. 3, 7, 9,
Land surface, oceans, atmosphere, and cryosphere have all changed as a result of industrialization and urbanization. Ecosystems are at the core of these systems, and they consist of the interdependent communities of plants, animals, and microorganisms as well as their non-living surroundings. 10 Ecosystems provide the resources that sustain human life on a variety of spatial scales (e.g. a field within a farm within a rural community within a region). Soil formation, climate regulation, and oxygen production are just a few of the many essential services provided by ecosystems. 12, 11 There is a direct link between environmental and climate change and ecosystem decline, which in turn has a direct impact on human health and well-being Instances 11 through 13
Damian Sendler
Changes in the Earth’s systems and ecosystems have been evident since the 19th century because of human activity.
However, since 1950, the pace and magnitude of anthropogenic change have accelerated sharply, with the decade marking the beginning of ‘The Great Acceleration’ in the human transformation of the global environment. 15 As a result, many species are unable to keep up with the rapid changes in their environment, which are resulting in the loss of biodiversity and oceanic ecosystems16, 17 as well as an increase in CO2 levels in the atmosphere and the surface temperature of the ocean. 18 These environmental stress indicators are taken as proof that human-induced alterations to Earth’s climate are causing a geological shift: humanity has emerged as a global geophysical force. The Earth is entering a new “human-dominated geological epoch” after the stable environmental boundaries of the Holocene epoch, during which human societies have grown and prospered. 19 A number of Earth’s systems have gone “no analog,” posing new and unprecedented threats to human health, many of which will fall disproportionately on the world’s poorest people, who have made the least contribution to global warming and environmental degradation thus far. The ages of 17 to 22
Consumerist lifestyles, in particular the high levels of consumption associated with affluent societies, have been implicated in environmental change and geological transition as a result of economic growth.
23 Population growth has increased environmental pressures, but it has been primarily due to an increase in per capita consumption of Earth’s finite resources by “a small fraction of the human population,” namely those living in high-income societies. 15 As a global aspiration and, increasingly, a global norm, the consumption patterns of wealthy societies are becoming increasingly damaging to the environment as a result of “a cultural globalization”24. 25 Emerging economies and other middle-income countries are increasingly driving environmental and climate change because of “the convergence of aspirations on high consumption patterns”26. 27
Research and policy on chronic disease and environmental change, though related, have been separated because of their common roots in modern society’s lifestyles. However, with environmental and climate change putting increasing pressure on both public and planetary health, there are increasing calls to bring health and environmental perspectives closer together. 22-22-28, 29-30-31 It’s our hope that our paper will help fulfill this urgent need.
We are aware of the barriers that can prevent cross-disciplinary and cross-sector understandings.
Damian Jacob Markiewicz Sendler: Barriers to ‘thinking outside the box’ include difficulties in accepting ideas and perspectives from other fields. A number of studies have shown that concepts can be helpful in this regard. Unlike evidence, they can mediate understandings and facilitate dialogue across disciplinary and policy boundaries. 35 Science studies concepts can be used as ‘boundary objects’ to connect the research and policy communities,36,37 in the language of science studies. Both social determinants and healthy lifestyles are important concepts in public health, so we’ll concentrate on them here. They are compared and contrasted with environmental perspectives to see if there are any points of convergence.
In the following section, we’ll talk about social determinants and the frameworks that have been used to identify the channels through which they exert their influence. Policy-facing research frequently employs frameworks, which are visual representations of complex processes, in order to facilitate cross-disciplinary and policy-related communication. 39, 38 A social determinants of health (SDH) perspective, we argue, obscures the natural environment’s position as an outcome shaped by the same factors that influence health. For example, many frameworks emphasize environmental change and ecosystem function over social determinants, and some of these frameworks include a focus on human health as an important consideration as well. A simple illustration of an integrated framework illustrates the synergies between the various frameworks.
Modern lifestyles are another focus for bridging public health and environmental perspectives in the following section. An environmental perspective on household consumption practices is discussed in this section to enhance public health’s focus on the individual and their behavioural risk factors. Public Health readers may be unfamiliar with some of the terms used in the paper, so the authors have provided an online glossary.
The concept of the SDH is frequently used as a basis for public health frameworks.
the 1970s, which was a time when governments in high-income countries were concerned about the economic and health burden of chronic disease. In the wake of a series of criticisms of a narrow focus on lifestyles as the cause of chronic disease, the concept was born. 42 Critically, critics argue that such a focus diverts attention from the social causation of disease, and advocate’refocusing upstream…toward a range of upstream political and economic forces’.. 44 WHO’s Health for All agenda emphasized these upstream influences, noting that health is “influenced by a complex of environmental, social, and economic factors ultimately related to one another.” 45
Damien Sendler: As far back as the early 1990s, Dahlgren and Whitehead provided a visual representation of this complex process. There were many interconnected factors that contributed to one’s overall well-being in their “rainbow” model of the most important health determinants. These factors ranged from broad societal factors like “general socioeconomic, cultural and environmental conditions” to more specific ones like “living conditions” and “individual lifestyle factors.” 46 The WHO’s Commission on the Social Determinants of Health47 and its subsequent reviews were based on the concept. 48 Both lifestyle risk factors and their broader determinants (the “causes” of those risk factors) are social in origin, as the reports made clear. Global and national public health policies have been shaped by SDH approaches,41, 49 with a particular emphasis on policies to improve access and quality of life. 51, 50
SDH approaches, on the other hand, have been less successful in articulating where and how the natural environment contributes to both individual and population health..
49, 52, 41 According to the WHO Commission’s focus on ‘the fundamental global and national structures of social hierarchy and the socially determined conditions these create’, its conceptual model emphasizes the’socioeconomic and political context’, to people’s social position (social class, gender and ethnicity), and to their material and psychosocial circumstances. There is no mention of the environment. Lalonde’s “fields” of health, which include environmental and lifestyle factors, are also included in other models, such as this one. 53 Water and sanitation are also included in Dahlgren and Whitehead’s “rainbow” framework,46 which includes environmental conditions as part of the overarching arc of the model (referred to in the model as “general socioeconomic, cultural, and environmental conditions”). The social environment, including housing, workplaces, and social relationships, has long been the primary focus of public research and policy, rather than on the biophysical environment in which it is embedded. 30; 41; and 54 As Rapport et al.55 note, the biophysical environment is ‘the human habitat’ and is being rapidly degraded by human activity. This absence matters.
Damian Jacob Sendler
Health frameworks that emphasize ‘the human habitat’, however, are more prevalent. Blum’s input-to-health model56, published in 1974, was an early example of this notion that the environment is a “huge input to health.” In addition to ‘natural environment’, ‘natural resources’, and “ecological balance,” his environmental input includes ‘natural resources’. Dahlgren and Whitehead’s framework is an example of a more recent framework. 57 The model’s outer arcs are widened, as shown in Fig. 1, to give more weight to environmental factors as health-related determinants. ‘Building environment,’ ‘natural environment,’ and ‘global ecosystem,’ or ‘climate change and biodiversity,’ are the three concentric arcs that make up the environment.
Because of their causal structure, they include the biophysical environment as a determinant, but not the social factors that have an impact on health. This is not to say that these factors do not have an impact on the biophysical environment, but rather that they play a key role in the Great Acceleration’s anthropogenic drivers. This suggests that the concept of the SDH is driving the change from the Holocene to a ‘human-dominated geological epoch. It is therefore necessary to position human health and Earth’s life-sustaining systems as outcomes of an integrated set of socially determined factors in frameworks.
Environmental science and policy frameworks provide a base from which to build. There are general frameworks for describing human-caused environmental change and its consequences, as well as frameworks that focus more specifically on changes in the essential services provided by ecosystems.
OECD’s Pressure-State-Response framework (PSR) is the first set of frameworks to have their roots in the OES.
59 In this model, economic and environmental agents are linked by a causal chain that begins with “pressures from human activities” and ends with “state of the environment and natural resources.” As a tool for environmental analysis, this well-known model has been refined over time.
As part of the European Environment Agency’s DPSIR framework, developed in the 1990s,
60 For example, human drivers (e.g. transportation) were distinguished from environmental pressures (CO2 emissions), and the state of the environment was separated from impacts (e.g. air, soil, water quality) (e.g. on human health and biodiversity). Environmental health indicators were further refined using the model. Between’state’ and ‘impacts,’ the word ‘exposure,’ was added. In order to better understand how the physical environment affects human health, Morris et al.63 developed an updated version of the original Driver-Pressure-State-Exposure-Effect-Action model61, 62. Contextual influences include “social, economic, demographic, and behavioral factors,” according to the revised framework.
Frameworks that focus on ecosystems and their essential role in sustaining human and planetary health also share the same basic causal structure.
64 The MEA, a global scientific assessment launched in 2001 under the auspices of the United Nations, documented this role. ‘Indirect drivers of change,’ “direct drivers of change,” “ecosystem services,” and ‘human well-being and poverty reduction’ make up the framework’s overarching conceptual framework11. Upstream forces and causes of the causes are generally referred to as ‘indirect drivers’, which include demographic, economic, and sociopolitical factors, in SDH perspective. Changes in land use and species introduction or removal, harvest and resource consumption, and climate change are all direct drivers in the MEA framework. Both sets of drivers, as well as related changes in ecosystem functioning, have an impact on human well-being (e.g. climate regulation and the capacity to provide food and water). Even though well-being refers to “basic material for a good life,” “health,” “good social relations,” and “security,” this component of the framework refers only to “freedom of choice and action.”
The MEA Health Synthesis report provides a detailed framework for understanding the links between human activity, environmental degradation, and human health.
17 This Health Synthesis Framework connects more directly with the SDH perspectives familiar to public health practitioners than does the overarching MEA framework (Fig. 2). Direct, ecosystem-mediated, and indirect health outcomes have been identified. Since ‘escalating human pressure on global environment’ is at the root of both PSR models and MEA framework, it follows that social factors are the primary ones. Clearly, there is a causal connection between the models that gives precedence to social determinants of health. 65 Their impact on biophysical conditions, ecosystem functioning, and, ultimately, human health is due to these external drivers.
Their common causal structure suggests that integrated frameworks that span public health and environmental sustainability are possible. MEA Health Synthesis framework (Fig. 2) has great potential because it is simple but covers important processes and links. Since social determinants have both direct and indirect effects on health, we use this framework to inform the schematic framework below (Fig. 3). From SDH and DPSIR frameworks and MEA approaches, the structure of this framework is intentionally based on other well-known policy frameworks. In the same way as these frameworks, it enables constituents of the framework (e.g. the interactions between social determinants and environmental change) to be represented in separate and more complex models.
The high-income society’s way of life is crucial in determining health and environmental conditions on a social level. In the following section, we examine public health and environmental viewpoints on modern lifestyles in greater detail.
There has always been a strong link between environmental conditions and human health. Until the mid-20th century, these conditions provided a stable foundation for society and health advancement. As a result, the free-market approach to economic and social development has taken the Earth’s resources beyond their stable boundaries, putting future generations at risk. Consumption-based lifestyles have played a key role in this process as a source of economic growth and prosperity. They have also played a significant role in the evolution of disease patterns.
There is a growing understanding that environmental sustainability and public health are inextricably linked. Because of this, they must be viewed and addressed as a whole. By focusing on concepts that illuminate their common causes, we have contributed to the development of a shared perspective. Within the field of public health, the concepts of social determinants and healthy lifestyles are well-known and widely used; they also have an environmental counterpart.
Public health research and policy are aided by the use of frameworks that include social determinants in their definitions. The frameworks, on the other hand, tend to obscure the effects of social determinants on broader environmental conditions. Individualistic and risk-focused approaches to disease causation are prevalent in the way lifestyles are viewed. These perspectives can be broadened through the use of environmental frameworks. They demonstrate that the ill effects of human activity on the planet’s natural systems and ecosystems can be traced back to the economic systems, built environments, and way of life of countries with affluence. Environmental perspectives that emphasize the household as a consumption unit can broaden and complement the focus on individual behavior in public health, as we found out in our research. Environmental and health impacts can lead to a variety of social gradients. We saw the potential for a combined framework in light of these synergies. Both human health and the environment are depicted as socially determined outcomes of dominant forms of economic and social development in our example.
In order to ensure that people can be healthy, the public health community is tasked with ensuring that the conditions are in place.
Public health and environmental sustainability must be integrated into a common agenda, with alliances and partnerships that connect across societies, disciplines, and policy areas.. This urgent global endeavor could use a little help from our paper.