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Part 1 Environmental health ethics in general
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The origin of environmental health happened because of the need to create a balance in the relationship between humankind and environment (Ribeiro, 2004). According to the World Health Organization (WHO), environmental health addresses all physical, chemical and biological factors external to a person that affect health and well-being. It thus includes the assessment and control of environmental factors that may affect health. It is intended to prevent disease and to create health-friendly environments.
In recent decades, humanity has transformed natural resources and ecosystems with a speed and extent never known before in history. Urbanization, population growth and economic growth have led to a complex environmental situation in which poor air quality, declining drinking water sources, soil and food contamination, and climate and environmental change are blended beyond the equilibrium capacities of ecosystems and individuals to maintain themselves (Soares da Silva, 2013).
In National Geographic, which has been paying particular attention to environmental issues globally, we can see several examples showing that something is happening with the environment in which we live and that our actions are severely degrading existing natural resources. Examples include the Aral Sea, between Kazakhstan and Uzbekistan, which was one of the four largest lakes in the world. After decades of serving to water cotton fields, it has almost disappeared! Or, the case of the Alaska Glacier Columbia, which flows directly into the sea and was roughly in the same position from 1794 (the year it was discovered) until 1980 and, as of 2014, that is within 18 years, the nose of the glacier retracted about 19 km, thus being one of the fastest disappearing glaciers in the world; or, Shanghai’s growth, and the theft of land for Dubai to grow, and the deforestation of the Amazon rainforest, are some of the many examples of what is going on in the world that are compromising the health and well-being of the world population.
Health and environment have always been closely related. However, a variation in the importance given to their relationship has been noted over time. It is considered that the first allusion to this relationship was made by Hippocrates. In his treatise ‘On air, water and places’ he talks of ‘fully recognizing the value of the principle of geographical conditions and climate influences on health’. In the nineteenth century, John Snow, pioneer in spatial epidemiology, discovered in 1854 that the epidemic of cholera that ravaged London was transmitted by water, a fundamental discovery that would subsequently control the spread of the disease. Already in the twentieth century in 1951, in Japan, pollution as a cause of disease was first highlighted in the city of Minamata. This serious disease, called Minamata disease, whose symptoms are mainly a weakening of the muscles that can go in extreme cases to madness, paralysis, coma and death in the following weeks, is caused by the release of methyl mercury into the water, causing mercury poisoning in people who consume the fish taken from this water. It is the first documented such study of the health impacts of the environment.
We consider that environmental health was elevated to a higher level with the publication of ‘Silent Spring’ by Rachel Carson. She focused on how DDT (dichlorodiphenyltrichloroethane), an organochlorine pesticide, enters the food chain and how it can affect not only birds, but also humans, establishing a clear relationship between the environment and the health of people exposed to a specific substance. DDT was the first modern pesticide widely used during and after World War II to combat mosquito vectors of diseases such as malaria and dengue.
But it has probably been with the ‘Love Canal’ case in the United States and ‘Chernobyl’ in Europe that the relationship between health and environment has become so evident and resulted in concrete actions, particularly in the Western world.
The Love Canal case occurred in the United States of America in a neighbourhood near Niagara Falls, New York, where, in the 1940s, a chemical company disposed of tons of chemical by-products onto lands over which in 1953 a school was built and a whole neighbourhood, where after an exceptionally rainy year in 1962, the chemicals started coming to the surface causing serious health problems in the local residents.
This case attracted national attention, and it was the genesis of the Superfund, a U.S. federal government programme designed to fund the clean-up of sites contaminated with hazardous substances and pollutants.
In 1986, a nuclear reactor exploded in the Chernobyl Nuclear Power Station, which is located near the city of Pripyat in the Ukraine. The radioactive cloud that formed after the disaster affected almost all of the countries in Europe. The world realized that the existence of borders did not protect from environmental contamination.
As a result of the Chernobyl catastrophe, European countries initiated the first-ever process to eliminate the most significant environmental threats to human health. Progress towards this goal has been driven by a series of ministerial conferences held every five years coordinated by WHO/Europe. These environment and health conferences are unique, bringing together different sectors to shape European policies and actions on environment and health. The first conference was held in Frankfurt in 1989. We can highlight the Fifth Conference held in Parma, Italy, on March 2010 that resulted in The Parma Declaration, the first time-limited outcome of the environment and health process. Governments of the 53 European member-states set clear targets to reduce the adverse health impacts of environmental threats in the next decade. As important was the Sixth Ministerial Conference on Environment and Health held in Ostrava Czech Republic in June 2017, and ‘The Ostrava Declaration’ was introduced with the motto ‘Better Health. Better Environment. Sustainable Choices’. This defined four goals:
- Leverage the European environment and health process to achieve selected Sustainable Development Goals;
- Addresses the ‘unfinished business’ of environment and health in Europe;
- Promote coherence across all policy levels and establish inclusive platforms for dialogue; and
- Develop national portfolios for action and strong intersectorial coordination.
To better achieve these goals, the WHO/Europe published a second assessment report on ‘Environmental health inequalities in Europe’ (2019), which considers the distribution of environmental risks and injuries within countries and shows that unequal environmental conditions, exposure risks and related health outcomes affect citizens daily in all settings where people live, work and spend their time. The report documents the magnitude of environmental health inequalities within countries through 19 inequality indicators on urban housing and working conditions, basic services and injuries. This report highlights that inequalities in risks and outcomes occur in all countries in the WHO European region. The latest evidence confirms that socially disadvantaged population subgroups are those most affected by environmental hazards, causing avoidable health effects and contributing to health inequalities.
At the Ostrava meeting, delegates agreed on the importance of addressing the need to accelerate progress on health and environment and, in particular, to address the environment-related health goals and targets of the 2030 Sustainable Development Agenda.
There are as many as 17 Sustainable Development Goals. They were adopted on 25 September 2015 in a way to address poverty, protect the planet and assure prosperity for all. All of the goals are interconnected; we highlight goal number 3 ‘Good Health and Well-being’ to ensure healthy lives and promote well-being for all at all ages. It is my conviction that this goal must be at the centre of all the other goals.
The WHO provides a panorama of objectives that must be taken into account. Nine facts for preventing disease are highlighted relating to healthy environments because today about one in four deaths across the globe are due to environmental factors and, according to the WHO, every year an estimated 12.6 million people die as a result of living or working in an unhealthy environment.
More than 100 diseases and injuries are related to environmental risk factors, such as air, water and soil pollution, chemical exposures, climate change and ultraviolet radiation. But there are also positive indicators – such as the number of deaths from infectious diseases such as diarrhoea and malaria, which are often related to poor water, sanitation and waste management – that have declined. This happened because of the improvements to basic sanitation such as the increases in access to safe water and sanitation alongside better access to immunization, insecticide-treated mosquito nets and essential medicines. But, despite all efforts to achieve better health among populations, it is important to highlight counter-current movements such as anti-vaccination groups. The measles example, a disease which had been declared eradicated in most European countries, saw cases reappearing in large numbers due to misinformed populations.
The WHO also highlights the relationship between the vulnerability to environmental-related diseases and the age of the population, emphasizing the fact that younger children and older people are most affected by these diseases. Annually, 1.7 million deaths in children under 5 years of age are attributable to the environment. The most prominent causes of death are lower respiratory tract infections, such as pneumonia, and diarrheal diseases. And 4.9 million deaths in adults between 50 and 75 years of age are attributable to the environment. Unlike children under 5, older adults are most affected by non-communicable diseases. It is also important take into account that environmental impacts are uneven across different social groups, not only by their social status, income, employment and education but also by noneconomic aspects such as age, gender and ethnicity.
Also the geographical place where people are born and live, as reported by WHO, helps to establish a relationship between environmental issues and the health of populations. Thus, low- and middle-income countries in the WHO Southeast Asia and Western Pacific regions had the largest environmentally related disease burden in 2012, with a total of 7.3 million deaths, most attributable to indoor and outdoor air pollution. But, at the same time, WHO with its stakeholders are working on prevention; they highlight the importance of the health and other sectors needing to work together to reduce the environmental burden of disease, such as reducing traffic congestion and improving public transport networks as important determinants of air pollution, and usually require cooperation with the transport sector and city planners. Because of this, it is important that local governance address environmental health planning. Municipalities are natural leaders of the local environment and health planning. They are often involved in developing the local economy, including transport, tourism and industry, and can play an important role in health planning if they are aware of the potential risks and benefits and are provided with the tools and support they need.
It is therefore increasingly important to pay attention to this phenomenon as the United Nations estimates that 66% of the world’s population will live in cities by 2050 and, according to James Canton (2011), by 2040, most of the world’s population will be living in megacities, cities containing at least 10 million people.
According to the World Bank (2015), town planning is important for understanding the maxim ‘think globally, act locally’. Urban management and development highly impacts the surrounding environment. The ways in which this is implemented are vital to the health of the environment. Corporations need to be aware of global communities when expanding their companies to new locations. Not only do corporations need to be aware of global differences, but they must also pay closer attention to urban and rural areas that plan on expanding or changing the dynamics of their communities. As stated by the World Bank (2015),
addressing the complex urban environmental problems, in order to improve urban livability through Urban Environmental Strategies, involves taking stock of the existing urban environmental problems, their comparative analysis and prioritization, setting out objectives and targets, and identification of various measures to meet these objectives.
The concept of a ‘circular city’ or a ‘circular city-region’ derives from the circular economy model applied in the spatial territorial dimension. It can be associated with the concept of a ‘self-sustainable’ regenerative city, as discussed by Zeleny (2010).
As the Ellen MacArthur Foundation mentioned at the report ‘CE100 Circularity in the Built Environment’ (2016), the circular economy model has been defined as an economic model which is ‘regenerative by design’, with the aim to retain as much value as possible of products, parts and materials, focusing on the lifecycle of materials to ‘close-the-loop’ by recovering all wastes as a resource for new productive cycles.
So cities must increasingly become circular cities and leave the concept of linear cities (take, make, leave). The circular city view should take into account the built environment, the energy system, urban mobility systems and the creation of an urban bioeconomy. Obviously, this transition cannot happen without a fundamental change in behaviour and thinking. Using without being a consumer or sharing rather than accumulating are the new (and old) ways of being in the world and the basis for building a circular economy in which society is the central focus without compromising resources that future generations will need.
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