First, it was a challenge to develop the report to this point, and considerable debate (and rewriting) among think-tank members has occurred. At the heart of this report is a growing concern about the rapid and unprecedented changes occurring in Earth’s environment and the effects such changes have on human and animal health, and social and ecological sustainability. Accumulating evidence is telling us that eco-social drivers, including climate change, energy insecurity, deforestation, antimicrobial and insecticide resistance, urban expansion, land clearance, agricultural intensification, habitat degradation, urban-industrial air pollution and counterfeit drugs are harmful to human health and the environment. Their combined influence is often synergistic; that is greater than their simple sum. These drivers already harm food yields and water availability in many regions, as well as influence the biology of microbes and the epidemiology of infectious diseases. Not surprisingly, the world’s most vulnerable, i.e., people living in poverty, older people, women and children, pay the highest price in disease and disability, compromised immunity and poor health outcomes as a result of these changes.
The report’s intent is neither to catalogue a litany of ills nor to duplicate what is already well-known (perhaps in some parts of the report we have done so – though what is well-known to environmentalists may be under-recognized by health workers). Exploring interconnections between eco-social drivers and their relationship to infectious diseases requires moving into unfamiliar analytic territory, using an approach that can dilute the specificity of more conventional information about particular diseases and their main cause(s). Indeed, there is some risk – at least in the early stages – that such an approach will meet resistance from the policy and research realms because of the perceived complexity of these problems when analysed within a systems context.
A further risk is that this integrative approach, with its attention to social, commercial, industrial and environmental practices, represents advocacy on behalf of people with limited political and economic power. Drawing attention to the contributory role of the various upstream drivers challenges powerful interests, such as companies involved in large-scale agro-industry or the mining and combustion of fossil fuels.
The report gathers historical and contemporary examples from across the world to catalogue the human and ecological harm from inaction and/or ill-conceived development as well as showcase ‘good news stories’ and the possibilities of well-thought out development and clever thinking. Noteworthy examples from the report include: biofuel plantations in Columbia, which may accelerate the spread of Chagas disease in South America; climate change and the potential for the northward spread of Schistosoma japonicum in China; and the emergence of infectious diseases such as SARS likely to result from the combination of intensive farming of civet cats and raccoon dogs, increased human-animal interactions and global travel.
The combined impact of these large-scale, often systemic, environmental changes may be a decline in the quality of human civilization this century, affecting critical elements needed for health such as food production and delivery systems, disaster relief, adequate and safe water supply and other core elements of public health. Conversely, the benefit to human population health from avoidance of such dismal scenarios would be great. The probability of that beneficial outcome can be maximized by a shift to sustainable technologies, practices and social priorities, including keeping within the global “carbon budget” and increasing our efforts in areas proven to accelerate the reduction of poverty, such as educating girls.
Avoiding a harmful destiny may result in future generations not fully understanding the importance of these health-promoting actions. Perhaps an analogy exists in the comparative reduction in tension about nuclear war. Today, most people under the age of 30 do not share the same understanding of the threat of nuclear war compared to older people, in part because they have not lived for several decades with this threat as a real possibility. However, few would argue that young people should face the equivalent level of threat to fully appreciate the benefits of relative global peace and non-nuclear arms proliferation. Similarly, reducing the risk of overwhelmingly adverse global environmental change would be a wonderful gift to the next generation, even if most will not fully understand the significance of this gift. Unfortunately, to date, the world is far from bestowing that sustainable legacy.